Provider Demographics
NPI:1710642905
Name:JOHNSON, ELIZABETH CLAIRE
Entity Type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:CLAIRE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2826 AMNICOLA HWY
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37406-3605
Mailing Address - Country:US
Mailing Address - Phone:423-417-3273
Mailing Address - Fax:
Practice Address - Street 1:2826 AMNICOLA HWY
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37406-3605
Practice Address - Country:US
Practice Address - Phone:423-417-3273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician