Individual
EBONY NICOLE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
126 LITHIA PINECREST RD, BRANDON, FL 33511-5347
(813) 358-6841
Mailing address
12319 FAIRLAWN DR, RIVERVIEW, FL 33579-3921
(813) 451-2501
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
SW18488
FL
Other
Enumeration date
05/21/2019
Last updated
08/06/2021
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