Provider Demographics
NPI:1003556127
Name:JOHNSON, UKAWIA TYEWUNN
Entity Type:Individual
Prefix:
First Name:UKAWIA
Middle Name:TYEWUNN
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 1:2655 N TALLY CT
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-4823
Mailing Address - Country:US
Mailing Address - Phone:251-232-2847
Mailing Address - Fax:
Practice Address - Street 1:2655 N TALLY CT
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-4823
Practice Address - Country:US
Practice Address - Phone:251-232-2847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5617G1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical