Kenneth Cornell Johnson Jr., CDCA

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

040353 Issued in OH

Practice address

91 Park Ave W
Mansfield, OH 44902-1630

Phone

(567) 307-7269

NPI assigned

May 10, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1525910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525910400000",
    "number": "1487144952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "232 WIMBLEDON DR",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "449062451",
            "telephone_number": "419-571-2188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "91 PARK AVE W",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "449021630",
            "telephone_number": "567-307-7269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KENNETH",
        "middle_name": "CORNELL",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "CDCA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-10",
        "last_updated": "2018-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "040353",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erica Marie Johnson, LPN
• Halle Johnson
• Heather Johnson
• Jessica Renee Johnson, CDCA
• Kalifa T Johnson
• Larissa Johnson
• Macy Necole Johnson
• Michael Jamar Johnson
• Michelle Johnson, MSW, LSW
• Nicole Martrice Johnson, LPN

• Addiction (Substance Use Disorder) Counselor in Mansfield, OH
• Providers in Mansfield, OH by specialty
• Addiction (Substance Use Disorder) Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2018; 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.