Provider Demographics
NPI:1780930586
Name:JOHNSON, JULIE LYNN (LCSW, ACSW)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:LYNN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9727 TOUCHTON RD
Mailing Address - Street 2:APT 1901
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-8229
Mailing Address - Country:US
Mailing Address - Phone:904-654-3275
Mailing Address - Fax:
Practice Address - Street 1:2021 PROFESSIONAL CENTER DR
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4461
Practice Address - Country:US
Practice Address - Phone:904-688-3000
Practice Address - Fax:904-688-3001
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-30
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW117901041C0700X, 104100000X
MO20080128521041C0700X
GACSW0043301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical