Provider Demographics
NPI:1205431517
Name:JOHNSON, HOPE ELAINE (LCSW)
Entity type:Individual
Prefix:
First Name:HOPE
Middle Name:ELAINE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:HOPE
Other - Middle Name:ELAINE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1 SOH COS/ SGOW
Mailing Address - Street 2:113 LIELMANIS
Mailing Address - City:HURLBURT FIELD
Mailing Address - State:FL
Mailing Address - Zip Code:32544
Mailing Address - Country:US
Mailing Address - Phone:850-881-5061
Mailing Address - Fax:
Practice Address - Street 1:19605 GREENO RD STE 1201
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-3898
Practice Address - Country:US
Practice Address - Phone:850-642-1859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
FL175481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL17548OtherLCSW NUMBER
AL4965COtherALABAMA LICENSE