Provider Demographics
NPI:1154467306
Name:JOHNSON, HIRAM K (MA, LCSW)
Entity Type:Individual
Prefix:MR
First Name:HIRAM
Middle Name:K
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MA, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22765 US HIGHWAY 98 STE A4
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-3501
Mailing Address - Country:US
Mailing Address - Phone:251-517-7585
Mailing Address - Fax:251-929-4217
Practice Address - Street 1:22765 US HIGHWAY 98 STE A4
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-3501
Practice Address - Country:US
Practice Address - Phone:251-517-7585
Practice Address - Fax:251-929-4217
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2023-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3241142C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S05392Medicare UPIN
000046041Medicare ID - Type Unspecified