Provider Demographics
NPI:1568956993
Name:JOHNSON, STEPHEN WHITE (LCSW)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:WHITE
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 WIND HAVEN DR STE 203
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-8035
Mailing Address - Country:US
Mailing Address - Phone:859-219-9800
Mailing Address - Fax:859-219-9883
Practice Address - Street 1:101 WIND HAVEN DR STE 203
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-8035
Practice Address - Country:US
Practice Address - Phone:859-219-9800
Practice Address - Fax:859-219-9883
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-19
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY443OtherTHE KENTUCKY BORAD OF SOCIAL WORK