Healthcare Provider Details

I. General information

NPI: 1780357913
Provider Name (Legal Business Name): LATONIA JOHNSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2021
Last Update Date: 12/14/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 MILL CREEK CIR
HINESVILLE GA
31313-3935
US

IV. Provider business mailing address

700 MILL CREEK CIR
HINESVILLE GA
31313-3935
US

V. Phone/Fax

Practice location:
  • Phone: 912-293-5832
  • Fax: 912-293-5832
Mailing address:
  • Phone: 912-293-5832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW009860
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: