Provider Demographics
NPI:1508091968
Name:JOHNSON, ANTOINETTE V (REGISTERED MENTAL HE)
Entity Type:Individual
Prefix:MRS
First Name:ANTOINETTE
Middle Name:V
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:REGISTERED MENTAL HE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10307 PLEASANT VIEW DR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-3853
Mailing Address - Country:US
Mailing Address - Phone:352-742-7566
Mailing Address - Fax:
Practice Address - Street 1:10307 PLEASANT VIEW DR
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-3853
Practice Address - Country:US
Practice Address - Phone:352-742-7566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH5785101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH5785Medicaid