Provider Demographics
NPI:1659551661
Name:JOHNSON, ANGELA LYN (LCSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:LYN
Last Name:JOHNSON
Suffix:
Gender:F
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:PSC 2 BOX 8474
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09012-0085
Mailing Address - Country:US
Mailing Address - Phone:314-479-2390
Mailing Address - Fax:
Practice Address - Street 1:RAMSTEIN AB BLDG 2121, 3RD. FLOOR
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:NY
Practice Address - Zip Code:09012
Practice Address - Country:US
Practice Address - Phone:314-479-2390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW256031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical