Individual
MRS. ELIZABETH JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
3120 N OAK STREET EXT STE B, VALDOSTA, GA 31602-5910
(229) 671-6100
(229) 671-6761
Mailing address
3120 N OAK STREET EXT STE C, VALDOSTA, GA 31602-5910
(229) 671-6100
(229) 671-6774
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
005053
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005053
LICENSE
GA
Enumeration date
05/04/2011
Last updated
05/04/2011
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