Healthcare Provider Details

I. General information

NPI: 1083095004
Provider Name (Legal Business Name): SHARON J. JOHNSON M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2015
Last Update Date: 06/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6116 AUDUBON MANOR BLVD
LITHIA FL
33547-5031
US

IV. Provider business mailing address

1009 MAITLAND CENTER COMMONS BLVD UNIT# 212
MAITLAND FL
32751-7270
US

V. Phone/Fax

Practice location:
  • Phone: 813-486-0702
  • Fax: 813-315-8965
Mailing address:
  • Phone: 407-636-3532
  • Fax: 321-256-5292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: