| Doctor Name: | DR. LARRY NORMAN JOHANNESSEN |
| NPI Number: | 1043488703 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHD MSW LCSW MDIV |
| License Number: | C003820 |
| Business Practice Address: | 825 Gumbranch Rd Suite 109 Jacksonville, NC - 28540 |
| Business Phone Number: | 9104555551 |
| Business Fax Number: | 9109382556 |
| Mailing Address: | 825 Gumbranch Rd, Suite 109 JACKSONVILLE |
| State: | NC |
| Postal Code: | 28540 |
| Phone Number: | 9104555551 |
| Fax Number: | 9109382556 |
| NPI Enumeration Date: | 02/15/2008 |
| NPI Last Update Date: | 02/15/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 104100000X |
| License Number: | C003820 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A social worker is a person who is qualified by a Social Work degree, and licensed, certified or registered by the state as a social worker to practice within the scope of that license. A social worker provides assistance and counseling to clients and their families who are dealing with social, emotional and environmental problems. Social work services may be rendered to individuals, families, groups, and the public. |