Provider Demographics
NPI:1891917035
Name:JOHNSON, LILLIE OLIVIA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LILLIE
Middle Name:OLIVIA
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 1:2301 W MICHIGAN AVE APT 39
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32526-2372
Mailing Address - Country:US
Mailing Address - Phone:850-944-0657
Mailing Address - Fax:
Practice Address - Street 1:FLEET AND FAMILY SUPPORT CENTER BUILDING 625 NAS
Practice Address - Street 2:151 ELLYSON AVE
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32508
Practice Address - Country:US
Practice Address - Phone:850-452-5990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 00013771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical