Provider Demographics
NPI:1053955476
Name:JOHNSON, DEBBIE RAE (LADC, LPCC)
Entity type:Individual
Prefix:
First Name:DEBBIE
Middle Name:RAE
Last Name:JOHNSON
Suffix:
Gender:
Credentials:LADC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26972 JAMES AVE
Mailing Address - Street 2:
Mailing Address - City:CHISAGO CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55013-9605
Mailing Address - Country:US
Mailing Address - Phone:612-479-8146
Mailing Address - Fax:
Practice Address - Street 1:6448 MAIN ST STE 1AND3
Practice Address - Street 2:
Practice Address - City:NORTH BRANCH
Practice Address - State:MN
Practice Address - Zip Code:55056-7068
Practice Address - Country:US
Practice Address - Phone:651-775-9804
Practice Address - Fax:844-364-7181
Is Sole Proprietor?:No
Enumeration Date:2019-10-29
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN305121101YA0400X
MNCC03414101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)