NPIMap

Organization Active NPI

Andra D. Johnson

Doing business as Four Rivers & Associates LLC

  • Clinical Social Worker
  • Fort Wayne, IN
National Provider Identifier
1336468271
Registry record updated Oct 17, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
34005636A Issued in IN
Legal business name
ANDRA D. JOHNSON
Doing business as
Four Rivers & Associates LLC
Practice address
4656 W Jefferson Blvd
Suite 285
Fort Wayne, IN 46804-6857
Phone
(260) 422-9372
Fax
(260) 672-0859
NPI assigned
May 18, 2010
Last updated
Oct 17, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2011

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

Authorized official

Name
Mrs. Andra D Johnson, LISW, LCSW, LCACNPI 1093787426
Title
Owner
Phone
(216) 798-1997

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 991842 OH
Addiction (Substance Use Disorder) Counselor 101YA0400X 87000438A IN
Clinical Social Worker 1041C0700X I-0009358 OH
Clinical Social Worker 1041C0700X 2972-123 WI
Clinical Social Worker 1041C0700X 34005636A IN Primary

Addresses

Primary practice location

4656 W Jefferson Blvd
Suite 285
Fort Wayne, IN 46804-6857

Mailing address

11014 Constantia CV
Roanoke, IN 46783-8910
Phone (216) 798-1997

Other identifiers 1

IdentifierTypeStateIssuer
39628200 (-31/078)MedicaidWI

Other names 1

  • Four Rivers & Associates LLC Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1274140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318809600000",
    "number": "1336468271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11014 CONSTANTIA CV",
            "city": "ROANOKE",
            "state": "IN",
            "postal_code": "467838910",
            "telephone_number": "216-798-1997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4656 W JEFFERSON BLVD",
            "address_2": "SUITE 285",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046857",
            "telephone_number": "260-422-9372",
            "fax_number": "260-672-0859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANDRA D. JOHNSON",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-18",
        "last_updated": "2011-10-17",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "ANDRA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "216-798-1997",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LISW, LCSW, LCAC"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "991842",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IN",
            "license": "87000438A",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I-0009358",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "2972-123",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34005636A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39628200 (-31/078)",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Four Rivers & Associates LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.