Provider Demographics
NPI:1174048896
Name:JOHNSON, TAMIKA M (LCSW)
Entity type:Individual
Prefix:MRS
First Name:TAMIKA
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-2429
Mailing Address - Country:US
Mailing Address - Phone:215-767-2338
Mailing Address - Fax:
Practice Address - Street 1:276 W CHERRY LN
Practice Address - Street 2:
Practice Address - City:SOUDERTON
Practice Address - State:PA
Practice Address - Zip Code:18964-2819
Practice Address - Country:US
Practice Address - Phone:215-767-2338
Practice Address - Fax:215-767-2338
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-03
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0195611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical