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Individual

MRS. TRACEY L JOHNSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
L.I.S.W.-CP

Contact information

Practice address
150 OAKLAND AVE, ROCK HILL, SC 29730-4073
(803) 334-4056
Mailing address
PO BOX 36144, ROCK HILL, SC 29732-0502
(803) 334-4056

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6970
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
570629234006
BCBS
SC
01
CJ5560
RAILROAD MEDICARE
SC
Enumeration date
11/13/2006
Last updated
08/14/2023
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