Provider Demographics
NPI:1821424805
Name:EPPERSON, JOHNNIE MAE (LMSW-IPR)
Entity Type:Individual
Prefix:
First Name:JOHNNIE
Middle Name:MAE
Last Name:EPPERSON
Suffix:
Gender:F
Credentials:LMSW-IPR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 424
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-0424
Mailing Address - Country:US
Mailing Address - Phone:214-232-4006
Mailing Address - Fax:210-661-6705
Practice Address - Street 1:5019 VIKING CORAL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78244-1671
Practice Address - Country:US
Practice Address - Phone:214-232-4006
Practice Address - Fax:210-661-6705
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28475171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator