Provider Demographics
NPI:1265807234
Name:JOHNSON, SHERYL (LMHC MCAP MAC)
Entity type:Individual
Prefix:
First Name:SHERYL
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMHC MCAP MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1177 DENAUD ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-6481
Mailing Address - Country:US
Mailing Address - Phone:904-703-8367
Mailing Address - Fax:
Practice Address - Street 1:4570 SAINT JOHNS AVE
Practice Address - Street 2:STE B
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-1848
Practice Address - Country:US
Practice Address - Phone:904-703-8367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-02
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 14962101YM0800X
FLADC0146082016101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)