Provider Demographics
NPI:1356407738
Name:JOHNSON, STEPHEN ANDREW (MS)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:ANDREW
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9471 BAYMEADOWS RD STE 301
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7936
Mailing Address - Country:US
Mailing Address - Phone:904-503-2634
Mailing Address - Fax:904-503-2637
Practice Address - Street 1:9471 BAYMEADOWS RD STE 301
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7936
Practice Address - Country:US
Practice Address - Phone:904-503-2634
Practice Address - Fax:904-503-2637
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4355-120104100000X
FLPMH 1054101YM0800X
WI3932-125101YM0800X
FLCAP 5369101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)