Provider Demographics
NPI:1013541028
Name:JOHNSON-MCKOY, TAMMY MICHELE (LCSWA)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:MICHELE
Last Name:JOHNSON-MCKOY
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:MICHELE
Other - Last Name:WADDELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8263 US HIGHWAY 701 N
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:28337-6371
Mailing Address - Country:US
Mailing Address - Phone:910-309-8185
Mailing Address - Fax:
Practice Address - Street 1:7417 KNIGHTDALE BLVD UNIT 101
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-8824
Practice Address - Country:US
Practice Address - Phone:910-261-8566
Practice Address - Fax:919-261-8569
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0141861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical