Provider Demographics
NPI:1497992440
Name:JOHNSON, ASHLEY DANELLE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:DANELLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:D
Other - Last Name:DAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 958539
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-8539
Mailing Address - Country:US
Mailing Address - Phone:870-508-7610
Mailing Address - Fax:870-508-7614
Practice Address - Street 1:624 HOSPITAL DR
Practice Address - Street 2:6 SOUTH
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-2955
Practice Address - Country:US
Practice Address - Phone:870-508-7820
Practice Address - Fax:870-508-7614
Is Sole Proprietor?:No
Enumeration Date:2009-01-13
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3726-C1041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5WW41OtherBCBS