Individual
JAKE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
3809 ROSEWOOD DR, COLUMBIA, SC 29205-3533
(803) 939-2642
(803) 754-7783
Mailing address
2427 TERRACE WAY, COLUMBIA, SC 29205-2341
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
15536
SC
Other
Enumeration date
04/03/2023
Last updated
04/03/2023
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