Provider Demographics
NPI:1780020636
Name:JOHNSON, MARTHA REED
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:REED
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 S EBENEZER RD
Mailing Address - Street 2:SNEED MIDDLE SCHOOL
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-8009
Mailing Address - Country:US
Mailing Address - Phone:843-673-1199
Mailing Address - Fax:843-679-6890
Practice Address - Street 1:1102 S EBENEZER RD
Practice Address - Street 2:SNEED MIDDLE SCHOOL
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-8009
Practice Address - Country:US
Practice Address - Phone:843-673-1199
Practice Address - Fax:843-679-6890
Is Sole Proprietor?:No
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor