Provider Demographics
NPI:1801503529
Name:JOHNSON, ANTONIA ALAINE (LCSW)
Entity type:Individual
Prefix:
First Name:ANTONIA
Middle Name:ALAINE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 SIMONTON CREST WAY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-3507
Mailing Address - Country:US
Mailing Address - Phone:914-606-1530
Mailing Address - Fax:
Practice Address - Street 1:941 SIMONTON CREST WAY
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-3507
Practice Address - Country:US
Practice Address - Phone:914-606-1530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-02
Last Update Date:2022-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0083181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical