Provider Information for 1063422905
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Ms. NICOLE JASMINE JOHNSON MSW, MA, LCSW
Sex: Female
NPI: 1063422905
Last Updated: 2013-12-09
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1063422905 | ||||||||
| Enumeration Date | 2006-08-09 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 101 SOUTH OLD COACHMAN RD. #115 CLEARWATER, FL 33765 United States Phone: 813-433-3562 | Fax: | ||||||||
| Primary Practice Address | 10000 BAY PINES BLVD BAY PINES, FL 33744-5005 United States Phone: 813-433-3562 | Fax: | ||||||||
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