Provider Demographics
NPI:1114498979
Name:JOHNSON, SARAH JANE (LICSW, PIP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:JANE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LICSW, PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2709 MOUNT ROYAL CIR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN BRK
Mailing Address - State:AL
Mailing Address - Zip Code:35216-1016
Mailing Address - Country:US
Mailing Address - Phone:205-936-0121
Mailing Address - Fax:
Practice Address - Street 1:2807 GREYSTONE COMMERCIAL BLVD STE 36
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-9601
Practice Address - Country:US
Practice Address - Phone:205-552-0417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1418-3626C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical