Provider Demographics
NPI:1962692582
Name:JOHNSON, VENESIA CANOY (MSW, LMSW)
Entity type:Individual
Prefix:MISS
First Name:VENESIA
Middle Name:CANOY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSW, LMSW
Other - Prefix:
Other - First Name:VENESIA
Other - Middle Name:CANOY
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301 PALMETTO PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-7872
Mailing Address - Country:US
Mailing Address - Phone:803-996-1500
Mailing Address - Fax:803-996-1510
Practice Address - Street 1:301 PALMETTO PARK BLVD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-7872
Practice Address - Country:US
Practice Address - Phone:803-996-1500
Practice Address - Fax:803-996-1510
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health