Provider Demographics
NPI:1083636336
Name:JOHNSON, THOMAS D (MSW)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:D
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3445 S VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHSIDE
Mailing Address - State:AL
Mailing Address - Zip Code:35907-8110
Mailing Address - Country:US
Mailing Address - Phone:256-442-8382
Mailing Address - Fax:256-413-7813
Practice Address - Street 1:206 RESCIA AVE
Practice Address - Street 2:
Practice Address - City:RAINBOW CITY
Practice Address - State:AL
Practice Address - Zip Code:35906-5933
Practice Address - Country:US
Practice Address - Phone:256-413-7154
Practice Address - Fax:256-413-7813
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0728C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical