Provider Demographics
NPI:1013280320
Name:JOHNSON, CAROLYN ANN (LCSW, CEAP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 DRUID RD S
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3846
Mailing Address - Country:US
Mailing Address - Phone:727-854-6266
Mailing Address - Fax:727-581-1575
Practice Address - Street 1:1106 DRUID RD S
Practice Address - Street 2:SUITE 201
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3846
Practice Address - Country:US
Practice Address - Phone:727-854-6266
Practice Address - Fax:727-581-1575
Is Sole Proprietor?:No
Enumeration Date:2012-02-16
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW52491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical