Provider Demographics
NPI:1760144471
Name:JOHNSON, TIFFANY ALEXIS (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ALEXIS
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2186 RIVER PARK CT
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-2040
Mailing Address - Country:US
Mailing Address - Phone:912-660-5465
Mailing Address - Fax:
Practice Address - Street 1:2186 RIVER PARK CT
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-2040
Practice Address - Country:US
Practice Address - Phone:912-660-5465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-10
Last Update Date:2021-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0073231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical