Healthcare Provider Details

I. General information

NPI: 1114568599
Provider Name (Legal Business Name): CASSANDRA BIVINS-JOHNSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CASSANDRA BIVINS

II. Dates (important events)

Enumeration Date: 10/07/2019
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 JON RD
WARRENVILLE SC
29851-2935
US

IV. Provider business mailing address

157 JON RD
WARRENVILLE SC
29851-2935
US

V. Phone/Fax

Practice location:
  • Phone: 803-295-2710
  • Fax:
Mailing address:
  • Phone: 803-295-2710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10198
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number015323
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: