Provider Demographics
NPI:1033484878
Name:JOHNSON, STEPHANIE ANN CHAMBERS
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANN CHAMBERS
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 PEACHTREE ST
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32922-7223
Mailing Address - Country:US
Mailing Address - Phone:321-252-4449
Mailing Address - Fax:
Practice Address - Street 1:906 PEACHTREE ST
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922-7223
Practice Address - Country:US
Practice Address - Phone:321-252-4449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-13
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH 9657101YM0800X
FLMH12231101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health