Provider Demographics
NPI:1295627487
Name:JOHNSON, MICHAEL CAROLINE (LMSW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CAROLINE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:110 KELLWOOD DR STE 22A
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-3263
Mailing Address - Country:US
Mailing Address - Phone:478-300-7020
Mailing Address - Fax:
Practice Address - Street 1:110 KELLWOOD DR STE 22A
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-3263
Practice Address - Country:US
Practice Address - Phone:478-300-7020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW011751104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker