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General NPI Number Information
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NPI Number | 1356407738
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Entity Type | Individual
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Provider Name | STEPHEN ANDREW JOHNSON MS
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Gender | Male
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Dates
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Enumeration Date | 12/29/2006
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Last Update Date | 10/15/2013
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Provider Practice Location Address
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Address Line | 9471 BAYMEADOWS RD STE 301
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City | JACKSONVILLE
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State | FL
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Zip | 32256-7936
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Country | US
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Telephone | 904-503-2634
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Fax | 904-503-2637
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Provider Business Mailing Address
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Address Line | 9471 BAYMEADOWS RD STE 301
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City | JACKSONVILLE
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State | FL
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Zip | 32256-7936
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Country | US
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Telephone | 904-503-2634
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Fax | 904-503-2637
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 4355-120
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | PMH 1054
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 3932-125
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CAP 5369
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License Number State | FL
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