Provider Demographics
NPI:1114568599
Name:BIVINS-JOHNSON, CASSANDRA
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:BIVINS-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 1:157 JON RD
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29851-2935
Mailing Address - Country:US
Mailing Address - Phone:803-295-2710
Mailing Address - Fax:
Practice Address - Street 1:9005 TWO NOTCH RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-5850
Practice Address - Country:US
Practice Address - Phone:803-335-5343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional