Basic Information
| Provider Information | |||||||||
| NPI: | 1003014564 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | KA'RA | ||||||||
| MiddleName: | CAPRIE | ||||||||
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| Credential: | CT, LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1485 HILLCREST ST | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443143147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3302563850 | ||||||||
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| Practice Location | |||||||||
| Address1: | 202 E BAGLEY RD | ||||||||
| Address2: | |||||||||
| City: | BEREA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440172058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402608453 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2007 | ||||||||
| LastUpdateDate: | 06/18/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | C.1300155TRNE | OH | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 104100000X | S.0600781 | OH | N | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.