Provider Demographics
NPI:1952496093
Name:JOHNSON, ANN MCCULLISS (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:MCCULLISS
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 1:9338 RIVER SHORES LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-4912
Mailing Address - Country:US
Mailing Address - Phone:904-737-3610
Mailing Address - Fax:
Practice Address - Street 1:9338 RIVER SHORES LN
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-4912
Practice Address - Country:US
Practice Address - Phone:904-737-3610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0037141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical