Provider Demographics
NPI:1760883664
Name:JOHNSON, TANISHA NICOLE (MA, LAPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:TANISHA
Middle Name:NICOLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA, LAPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2724 BEYNON LN
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-7296
Mailing Address - Country:US
Mailing Address - Phone:678-770-2712
Mailing Address - Fax:
Practice Address - Street 1:2724 BEYNON LN
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-7296
Practice Address - Country:US
Practice Address - Phone:678-770-2712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC004251101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health