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Individual

ANDRA CAVEN JOHNSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LSW

Contact information

Practice address
3958 BROWN PARK DR STE D, HILLIARD, OH 43026-1160
(510) 201-0190
(888) 972-2903
Mailing address
3675 E 140TH ST, CLEVELAND, OH 44120-4548
(216) 632-3022

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
S.0032144
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
S0032144
MEDICAL LICENSE
OH
Enumeration date
09/13/2018
Last updated
09/13/2018
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