Provider Demographics
NPI:1437817681
Name:JOHNSON, MASIE ANNA (LMSW)
Entity Type:Individual
Prefix:
First Name:MASIE
Middle Name:ANNA
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 1:187 BELMONT DR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-6500
Mailing Address - Country:US
Mailing Address - Phone:334-671-1280
Mailing Address - Fax:334-671-0475
Practice Address - Street 1:172 BELMONT DR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-6504
Practice Address - Country:US
Practice Address - Phone:334-449-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-06
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4911G104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker