Provider Demographics
NPI:1467227553
Name:JOHNSON, ANTHONY (LMHC)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-9018
Mailing Address - Country:US
Mailing Address - Phone:904-463-0832
Mailing Address - Fax:
Practice Address - Street 1:12627 SAN JOSE BLVD STE 203
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-8638
Practice Address - Country:US
Practice Address - Phone:904-463-0832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH22964101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health