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General NPI Number Information
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NPI Number | 1255347241
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Entity Type | Individual
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Provider Name | SANDRA ELLEN JOHNSON-HARRIS L.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2728 COLONIAL AVE SW SUITE 117
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City | ROANOKE
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State | VA
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Zip | 24015-3878
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Country | US
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Telephone | 540-353-7231
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Fax | 540-254-2937
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Provider Business Mailing Address
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Address Line | PO BOX 98
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City | FINCASTLE
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State | VA
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Zip | 24090-0098
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Country | US
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Telephone | 540-353-7231
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Fax | 540-254-2937
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904002718
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License Number State | VA
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