Provider Demographics
NPI:1629140512
Name:JOHNSON, JOYCE W (LMSW)
Entity Type:Individual
Prefix:MS
First Name:JOYCE
Middle Name:W
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 2840
Mailing Address - Street 2:
Mailing Address - City:RAY CITY
Mailing Address - State:GA
Mailing Address - Zip Code:31645-9728
Mailing Address - Country:US
Mailing Address - Phone:229-896-4559
Mailing Address - Fax:229-869-7663
Practice Address - Street 1:1905 S HUTCHINSON AVE
Practice Address - Street 2:
Practice Address - City:ADEL
Practice Address - State:GA
Practice Address - Zip Code:31620-5246
Practice Address - Country:US
Practice Address - Phone:229-896-4559
Practice Address - Fax:229-896-7663
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW002210104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker