Provider Demographics
NPI:1154570521
Name:JOHNSON-MARTIN, YOLANDA C (LCSW)
Entity type:Individual
Prefix:MS
First Name:YOLANDA
Middle Name:C
Last Name:JOHNSON-MARTIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:YOLANDA
Other - Middle Name:C
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:PO BOX 971
Mailing Address - Street 2:
Mailing Address - City:CROSSETT
Mailing Address - State:AR
Mailing Address - Zip Code:71635-0971
Mailing Address - Country:US
Mailing Address - Phone:870-500-1997
Mailing Address - Fax:
Practice Address - Street 1:304 MAIN ST
Practice Address - Street 2:
Practice Address - City:CROSSETT
Practice Address - State:AR
Practice Address - Zip Code:71635
Practice Address - Country:US
Practice Address - Phone:870-500-2324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR6815-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR227892719Medicaid
AR5CW73OtherBCBS