Provider Demographics
NPI:1619271533
Name:JOHNSON, TAMARA ANTIONETTE (PHD)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:ANTIONETTE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1936 SHERIDAN RD
Mailing Address - Street 2:MULTICULTURAL CENTER, NORTHWESTERN UNIVERSITY
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60208-0849
Mailing Address - Country:US
Mailing Address - Phone:847-491-3917
Mailing Address - Fax:
Practice Address - Street 1:1936 SHERIDAN RD
Practice Address - Street 2:MULTICULTURAL CENTER, NORTHWESTERN UNIVERSITY
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60208-0849
Practice Address - Country:US
Practice Address - Phone:847-491-3917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling