Provider Demographics
NPI:1083768345
Name:JOHNSON, CYNTHIA LYNN (LCSW LICENESED CLINI)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LYNN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW LICENESED CLINI
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:LYNN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 61
Mailing Address - Street 2:
Mailing Address - City:ADAMSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38310-0061
Mailing Address - Country:US
Mailing Address - Phone:731-315-1213
Mailing Address - Fax:731-315-1213
Practice Address - Street 1:106 ASH ST
Practice Address - Street 2:
Practice Address - City:ADAMSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38310-4961
Practice Address - Country:US
Practice Address - Phone:731-315-1213
Practice Address - Fax:731-315-1213
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000044541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
3699144Medicare ID - Type Unspecified