Provider Demographics
NPI:1801284351
Name:LAWSON, JOHNNIE JR
Entity type:Individual
Prefix:
First Name:JOHNNIE
Middle Name:
Last Name:LAWSON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1745 HOBBS RD
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33823-4643
Mailing Address - Country:US
Mailing Address - Phone:863-412-0832
Mailing Address - Fax:863-937-9353
Practice Address - Street 1:1745 HOBBS RD
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:FL
Practice Address - Zip Code:33823-4643
Practice Address - Country:US
Practice Address - Phone:863-412-0832
Practice Address - Fax:863-937-9353
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker