Provider Demographics
NPI:1093958696
Name:JOHNSON, STEVEN HENRY
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:HENRY
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 3RD AVE NE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36265-1101
Mailing Address - Country:US
Mailing Address - Phone:256-782-3227
Mailing Address - Fax:
Practice Address - Street 1:96 ALI WAY
Practice Address - Street 2:CREEKSIDE SOUTH
Practice Address - City:OXFORD
Practice Address - State:AL
Practice Address - Zip Code:36203-1835
Practice Address - Country:US
Practice Address - Phone:256-832-4141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2385G1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical