Provider Demographics
NPI:1366672289
Name:JOHNSON, SONYA CAMILLE (LMSW)
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:CAMILLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 WAVERLY PLACE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-7117
Mailing Address - Country:US
Mailing Address - Phone:803-699-6069
Mailing Address - Fax:
Practice Address - Street 1:1301 WAVERLY PLACE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-7117
Practice Address - Country:US
Practice Address - Phone:803-699-6069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7205104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker