Provider Demographics
NPI:1629248968
Name:JOHNSON, SYLVIA D (MA, LPA)
Entity Type:Individual
Prefix:MS
First Name:SYLVIA
Middle Name:D
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA, LPA
Other - Prefix:PROF
Other - First Name:SYLVIA
Other - Middle Name:D
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LPA
Mailing Address - Street 1:2817 REILLY ST
Mailing Address - Street 2:WOMACK ARMY MEDICAL CENTER
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310-7324
Mailing Address - Country:US
Mailing Address - Phone:910-907-8922
Mailing Address - Fax:910-907-6069
Practice Address - Street 1:2817 REILLY ST
Practice Address - Street 2:WOMACK ARMY MEDICAL CENTER
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-7324
Practice Address - Country:US
Practice Address - Phone:910-907-7568
Practice Address - Fax:910-907-6069
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2294103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling