Provider Demographics
NPI:1619292786
Name:JOHNSON, TRISHA LEANN (MSW, P-LCSW)
Entity Type:Individual
Prefix:MS
First Name:TRISHA
Middle Name:LEANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSW, P-LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3259 BRIXTON CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-3332
Mailing Address - Country:US
Mailing Address - Phone:404-644-0170
Mailing Address - Fax:
Practice Address - Street 1:1927 JN PEASE PL
Practice Address - Street 2:104
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4553
Practice Address - Country:US
Practice Address - Phone:704-548-5298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0056371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical