Provider Demographics
NPI:1316290059
Name:JOHNSON, KENDALL A (LMSW)
Entity type:Individual
Prefix:MRS
First Name:KENDALL
Middle Name:A
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 COASTAL VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-1974
Mailing Address - Country:US
Mailing Address - Phone:912-554-8510
Mailing Address - Fax:
Practice Address - Street 1:275 FIRST STREET EXT
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:GA
Practice Address - Zip Code:31329-0000
Practice Address - Country:US
Practice Address - Phone:912-754-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW001211104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker