Individual ProviderDwayne Arra JohnsonSocial WorkerBehavioral Health & Social Service ProvidersPractice Address1276 N Clybourn Ave, Chicago, IL 60610-2003(312) 337-1073(773) 676-3675PECOS EnrollmentThis provider is enrolled in PECOS as DWAYNE JOHNSON.Based on the most recent information from CMS, provider Dwayne Arra Johnson is legally eligible to order and refer claims for DME services only.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1811600745Provider TypeIndividualFull NameJohnson, Dwayne ArraTitleMr.CredentialLCSWGenderMaleSole ProprietorYesEnumeration Date1/5/2023Last Updated1/5/2023Contact InformationPractice LocationPractice Address1276 N Clybourn Ave, Chicago, IL 60610-2003Phone(312) 337-1073FaxUnlisted FaxMailing LocationMailing Address807 Marion Way, Chicago Heights, IL 60411-1949Phone(773) 676-3675FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode1041C0700XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicense149.024414Illinois