Healthcare Provider Details

I. General information

NPI: 1003394602
Provider Name (Legal Business Name): SCOTT ALLISON JOHNSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2018
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 E CHURCH ST STE B
WARREN AR
71671-3530
US

IV. Provider business mailing address

PO BOX 509
DERMOTT AR
71638-0509
US

V. Phone/Fax

Practice location:
  • Phone: 870-226-6754
  • Fax:
Mailing address:
  • Phone: 870-538-5414
  • Fax: 870-538-5412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8895-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: