Provider Demographics
NPI:1689799710
Name:JOHNSON, ASHLEA ELEANOR (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEA
Middle Name:ELEANOR
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 1:421 SHADY PINE CT
Mailing Address - Street 2:
Mailing Address - City:MINNEOLA
Mailing Address - State:FL
Mailing Address - Zip Code:34715-5682
Mailing Address - Country:US
Mailing Address - Phone:407-222-0528
Mailing Address - Fax:352-241-0967
Practice Address - Street 1:655 W HIGHWAY 50
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2982
Practice Address - Country:US
Practice Address - Phone:352-536-2364
Practice Address - Fax:352-536-2370
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW7719101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health