Provider Demographics
NPI:1558816116
Name:JOHNSON, SHEILA (RBT)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:SHEILA
Other - Middle Name:EVONNE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RBT
Mailing Address - Street 1:1310 BOONE HILL RD APT 6E
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-2441
Mailing Address - Country:US
Mailing Address - Phone:843-609-9420
Mailing Address - Fax:
Practice Address - Street 1:1310 BOONE HILL RD APT 6E
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-2441
Practice Address - Country:US
Practice Address - Phone:843-609-9420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCRBT-16-22073103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst