Melissa Ann Johnson, LCSW, LCAS, CCS

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C008895 Issued in NC

Practice address

2554 Lewisville Clemmons Rd Ste 112
Clemmons, NC 27012-9927

Phone

(336) 283-2510

Fax

(336) 776-0091

NPI assigned

Jan 10, 2008

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Achieving Changes Counseling Services PLLCGroup PAC ID 6002161296, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Achieving Changes Counseling Services, PLLC

  • Clinical Social Worker
  • Clemmons, NC
  • NPI 1871008672

  Addiction (Substance Use Disorder)

  Medicare reassignment Care Compare group NPD Authorized official
• West Forsyth Pain Management

  • Medical Physician Assistant
  • Clemmons, NC
  • NPI 1053692079
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1199923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657670400000",
    "number": "1215113162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1417",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270121417",
            "telephone_number": "336-283-2510",
            "fax_number": "336-776-0091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2554 LEWISVILLE CLEMMONS RD STE 112",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270129927",
            "telephone_number": "336-283-2510",
            "fax_number": "336-776-0091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MELISSA",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "LCSW, LCAS, CCS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-01-10",
        "last_updated": "2022-07-13",
        "certification_date": "2022-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "CCS-20157",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "LCAS 3167",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C008895",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1215113162",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stephanie Marie Jasso
• Caitlin Evey Jennings
• Kyle Joseph Jensen
• Candice Darcy Johnson-Leonard, ANP-C
• Kimberly D Johnson
• Randy J. Johnson, LCMHC
• Brandi Lelia Holmes Jones, PA-C
• Colton Jones, PHARMD
• Jada Jordan
• Nicholaos Kalogeromitros

• Clinical Social Worker in Clemmons, NC
• Providers in Clemmons, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.