Provider Demographics
NPI:1477939551
Name:JOHNSON-GILCHRIST, TANYA JEANNE (LCSW, MSW, MPH, CPH)
Entity Type:Individual
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First Name:TANYA
Middle Name:JEANNE
Last Name:JOHNSON-GILCHRIST
Suffix:
Gender:F
Credentials:LCSW, MSW, MPH, CPH
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6823
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33608-0823
Mailing Address - Country:US
Mailing Address - Phone:813-609-2655
Mailing Address - Fax:
Practice Address - Street 1:323 VINE CLIFF ST
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570-4935
Practice Address - Country:US
Practice Address - Phone:813-609-2655
Practice Address - Fax:813-381-3909
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-30
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 128681041C0700X
FL94572083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine