Provider Demographics
NPI:1538108899
Name:JOHNSON, JAMES RANDALL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:RANDALL
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2407 ALLEN FERRY RD
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37166-7218
Mailing Address - Country:US
Mailing Address - Phone:615-597-3322
Mailing Address - Fax:
Practice Address - Street 1:5736 MANCHESTER HWY
Practice Address - Street 2:
Practice Address - City:MORRISON
Practice Address - State:TN
Practice Address - Zip Code:37357-7503
Practice Address - Country:US
Practice Address - Phone:931-815-1212
Practice Address - Fax:931-815-1221
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000041991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical