Provider Demographics
NPI:1841603487
Name:JOHNSON, SYLVIA
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:
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 1:1163 COLUMBIA ROAD 26
Mailing Address - Street 2:
Mailing Address - City:EMERSON
Mailing Address - State:AR
Mailing Address - Zip Code:71740-9532
Mailing Address - Country:US
Mailing Address - Phone:870-904-3533
Mailing Address - Fax:
Practice Address - Street 1:100 E UNIVERSITY
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71753-2181
Practice Address - Country:US
Practice Address - Phone:870-235-4911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1705308101YP2500X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR$$$$$$$$$Medicaid