Provider Demographics
NPI:1326526542
Name:JOHNSON, AMBER DAWN (LCSW)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:DAWN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:
Other - Last Name:TORMOLLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14893 HIGHWAY P
Mailing Address - Street 2:
Mailing Address - City:GRAVOIS MILLS
Mailing Address - State:MO
Mailing Address - Zip Code:65037-3915
Mailing Address - Country:US
Mailing Address - Phone:573-692-2988
Mailing Address - Fax:
Practice Address - Street 1:17019 N STATE HIGHWAY 5 STE C1
Practice Address - Street 2:
Practice Address - City:SUNRISE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65079-7034
Practice Address - Country:US
Practice Address - Phone:573-692-2988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-31
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20190352501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical