Provider Demographics
NPI:1548873490
Name:JOHNSON, SOULEIKA
Entity type:Individual
Prefix:
First Name:SOULEIKA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6231 OLD EBENEZER RD
Mailing Address - Street 2:
Mailing Address - City:LATTA
Mailing Address - State:SC
Mailing Address - Zip Code:29565-5241
Mailing Address - Country:US
Mailing Address - Phone:843-245-9875
Mailing Address - Fax:
Practice Address - Street 1:6231 OLD EBENEZER RD
Practice Address - Street 2:
Practice Address - City:LATTA
Practice Address - State:SC
Practice Address - Zip Code:29565-5241
Practice Address - Country:US
Practice Address - Phone:843-245-9875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor