Provider Demographics
NPI:1295412401
Name:JOHNSON, ASHLYN MARIE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:ASHLYN
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MISS
Other - First Name:ASHLYN
Other - Middle Name:MARIE
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:373 EMMA DR
Mailing Address - Street 2:
Mailing Address - City:BROOKLAND
Mailing Address - State:AR
Mailing Address - Zip Code:72417-9100
Mailing Address - Country:US
Mailing Address - Phone:501-326-8878
Mailing Address - Fax:
Practice Address - Street 1:4100 LINWOOD DR
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-8895
Practice Address - Country:US
Practice Address - Phone:870-336-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR12994-M104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker