Provider Demographics
NPI:1669090130
Name:JOHNSON, QUASHON ADAIRE SR (LCSW)
Entity type:Individual
Prefix:MR
First Name:QUASHON
Middle Name:ADAIRE
Last Name:JOHNSON
Suffix:SR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 BROOK TRL
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-6140
Mailing Address - Country:US
Mailing Address - Phone:404-735-1366
Mailing Address - Fax:
Practice Address - Street 1:6635 BASS RD BLDG 92145
Practice Address - Street 2:
Practice Address - City:FORT BENNING
Practice Address - State:GA
Practice Address - Zip Code:31905-5602
Practice Address - Country:US
Practice Address - Phone:706-257-7205
Practice Address - Fax:706-626-0827
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK70871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical