Provider Demographics
NPI:1710013248
Name:JOHNSON, JENNIFER LASHALL (CMSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LASHALL
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 KENDAL CT
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-4760
Mailing Address - Country:US
Mailing Address - Phone:706-447-4995
Mailing Address - Fax:
Practice Address - Street 1:156 UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-5314
Practice Address - Country:US
Practice Address - Phone:706-791-1683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5666104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker