Provider Demographics
NPI:1487983557
Name:JOHNSON, CASSANDRA LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:LYNN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:LYNN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:127 TUNSTALL RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-4236
Mailing Address - Country:US
Mailing Address - Phone:434-835-4476
Mailing Address - Fax:
Practice Address - Street 1:127 TUNSTALL RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-4236
Practice Address - Country:US
Practice Address - Phone:540-463-3141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-18
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040072601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical