Provider Demographics
NPI:1053186700
Name:JOHNSON, SANDRA DEE (MHSC, CTP)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:DEE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MHSC, CTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:573 KIT ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-2025
Mailing Address - Country:US
Mailing Address - Phone:904-233-5417
Mailing Address - Fax:
Practice Address - Street 1:573 KIT ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-2025
Practice Address - Country:US
Practice Address - Phone:904-233-5417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health