Provider Demographics
NPI:1922011238
Name:JOHNSON, LINDA HAMMETT (LCSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:HAMMETT
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 1:615 E MATTHEWS AVE
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-3145
Mailing Address - Country:US
Mailing Address - Phone:870-930-9090
Mailing Address - Fax:870-931-4581
Practice Address - Street 1:615 E MATTHEWS AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3145
Practice Address - Country:US
Practice Address - Phone:870-930-9090
Practice Address - Fax:870-931-4581
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1291-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5X602OtherBLUECROSS BLUESHIELD
AR5X602Medicare ID - Type Unspecified