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MR. JACKIE EUGENE JOHNSON SR. CADC II/QMHP-C, CSWA
NPI 1770745457
Counselor - Addiction (Substance Use Disorder) in Gresham, OR

Active since June 25, 2008
355 NW DIVISION ST, GRESHAM, OR 97030(503) 231-2641(503) 231-1654 Get Directions Write a Review

NPPES record last updated: January 30, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Mr. Jackie Eugene Johnson Sr. Cadc Ii/qmhp-c, Cswa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. JACKIE EUGENE JOHNSON SR. CADC II/QMHP-C, CSWA (NPI 1770745457) is an individual addiction (substance use disorder) provider in Gresham, Oregon, licensed in Oregon (00-11-45) and active in the NPI registry since June 2008.

NPPES Registry Identity

NPI1770745457
Entity TypeIndividualMale
Primary Taxonomy101YA0400X
Provider Legal NameMR. JACKIE EUGENE JOHNSON SR.Credential: CADC II/QMHP-C, CSWA
Location Address355 NW DIVISION STGresham, OR 97030-5523
Mailing Address1776 Sw Madison StPortland, OR 97205-1715 · (503) 224-1044 · Fax (503) 621-2235
Phone(503) 231-2641
Fax(503) 231-1654
Sole ProprietorNo
Enumeration DateJune 25, 2008
Last NPPES UpdateJanuary 30, 2025
NPPES CertifiedJanuary 30, 2025
✔ NPI 1770745457 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyCounselor · Addiction (Substance Use Disorder)Behavioral Health & Social Service Providers
Taxonomy Code101YA0400X
Licenses✔ Licensed in OR · 00-11-45✔ Licensed in OR · 17-CRM-078
Also ListedCounselor · Mental HealthTaxonomy 101YM0800X · License 24-QMHPC-001514 (OR)
Also ListedSocial Worker · ClinicalTaxonomy 1041C0700X · License A11750 (OR)
355 NW DIVISION ST, Gresham, OR 97030
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Other Names 1

Professional Name (2)Mr. Jack Eugene Johnson Cadc Ii/qmhp-r

Other Identifiers 2

Medicaid500800849OR
Medicaid500801135OR

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Moda Health Plan, Inc..Insurance ›

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DEANNA RAE SHIELDS CADC-R/CRM/PSS
Counselor (Addiction (Substance Use Disorder))
355 NW DIVISION ST
GRESHAM, OR 97030
Multnomah County (503) 231-2641
MS. TARA JOELLE WALKER QMHP, MS
Counselor (Mental Health)
355 NW DIVISION ST
GRESHAM, OR 97030
Multnomah County (503) 231-2641
MELISSA A JONES CRM/PSS/QMHA-R
Counselor (Addiction (Substance Use Disorder))
355 NW DIVISION ST
GRESHAM, OR 97030
Multnomah County (503) 231-2641
PRESTON FABRE PWS, CRM II
Peer Specialist
355 NW DIVISION ST
GRESHAM, OR 97030
Multnomah County (503) 231-2641
KAYLEN ANNMARIE SCOTT PWS,CRM
Counselor (Addiction (Substance Use Disorder))
355 NW DIVISION ST
GRESHAM, OR 97030
Multnomah County (971) 225-6695
MR. DAVID MADISON HUMPHRIES CADC I/CRM II
Counselor (Addiction (Substance Use Disorder))
355 NW DIVISION ST
GRESHAM, OR 97030
Multnomah County (971) 225-6695
MRS. SHANNON LORRAINE LEWIS CRM
Counselor (Addiction (Substance Use Disorder))
355 NW DIVISION ST
GRESHAM, OR 97030
Multnomah County (971) 255-6695
JOLYNN DENISE SHAFFER CRM II/QMHA-R
Counselor (Addiction (Substance Use Disorder))
355 NW DIVISION ST
GRESHAM, OR 97030
Multnomah County (971) 225-6695

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jackie Johnson's NPI number?

The NPI number for Jackie Johnson is 1770745457. It was assigned to this individual provider in the NPPES registry on June 25, 2008. The provider is also known as Mr. Jack Eugene Johnson Cadc Ii/Qmhp-R.

Where is Jackie Johnson located?

Jackie Johnson practices at 355 NW Division St, Gresham, OR 97030. The listed phone number is (503) 231-2641.

What is Jackie Johnson's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Addiction (Substance Use Disorder), with taxonomy code 101YA0400X.

What insurance does Jackie Johnson accept?

Health plans from Moda Health Plan, Inc. list Jackie Johnson as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Jackie Johnson was last updated on January 30, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.