Individual
JACYE A JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CSW
Contact information
Practice address
1200 LAKE HEARN DR NE, SUITE 250, ATLANTA, GA 30319-1415
(404) 943-1070
(404) 943-0890
Mailing address
9882 VISTA CIR, UNION CITY, GA 30291-6022
(770) 964-2024
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW003228
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
037384362
DRIVERS LICENSE
GA
Enumeration date
08/18/2010
Last updated
08/18/2010
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