Provider Demographics
NPI:1013243542
Name:JOHNSON, TABITHA RENEE (PHD, LMFT)
Entity Type:Individual
Prefix:DR
First Name:TABITHA
Middle Name:RENEE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:TABITHA
Other - Middle Name:RENEE
Other - Last Name:STAIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2950 HALCYON LN
Mailing Address - Street 2:SUITE #605
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-6689
Mailing Address - Country:US
Mailing Address - Phone:904-302-5340
Mailing Address - Fax:904-800-1211
Practice Address - Street 1:2950 HALCYON LN
Practice Address - Street 2:SUITE #605
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-6689
Practice Address - Country:US
Practice Address - Phone:904-302-5340
Practice Address - Fax:904-800-1211
Is Sole Proprietor?:No
Enumeration Date:2009-10-17
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist