Provider Demographics
NPI:1114175841
Name:FLOYD, SHONTINA JOHNSON (LCSW, CFSW, C-ASWCM)
Entity Type:Individual
Prefix:MRS
First Name:SHONTINA
Middle Name:JOHNSON
Last Name:FLOYD
Suffix:
Gender:F
Credentials:LCSW, CFSW, C-ASWCM
Other - Prefix:
Other - First Name:SHONTINA
Other - Middle Name:PATRYCE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1287 MARKS CHURCH RD STE 1
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6330
Mailing Address - Country:US
Mailing Address - Phone:706-373-0579
Mailing Address - Fax:844-385-8096
Practice Address - Street 1:1287 MARKS CHURCH RD STE 1
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909
Practice Address - Country:US
Practice Address - Phone:706-373-0579
Practice Address - Fax:844-385-8096
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-06
Last Update Date:2018-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSW115941041C0700X
GACSW0051981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical