Provider Demographics
NPI:1801394382
Name:TONYA DORLINE JOHNSON LCSW LLC
Entity Type:Organization
Organization Name:TONYA DORLINE JOHNSON LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:DORLINE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:757-291-3339
Mailing Address - Street 1:610 THIMBLE SHOALS BLVD STE 403
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-2573
Mailing Address - Country:US
Mailing Address - Phone:757-534-7840
Mailing Address - Fax:757-534-7844
Practice Address - Street 1:610 THIMBLE SHOALS BLVD STE 404
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4509
Practice Address - Country:US
Practice Address - Phone:757-291-3339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TONYA DORLINE JOHNSON LCSW
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health