Provider Demographics
NPI:1720681034
Name:JOHNSON-TABB, JAMIKA MICHELLE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JAMIKA
Middle Name:MICHELLE
Last Name:JOHNSON-TABB
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3911 MULKEY WAY
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1102
Mailing Address - Country:US
Mailing Address - Phone:404-702-6694
Mailing Address - Fax:
Practice Address - Street 1:3911 MULKEY WAY
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1102
Practice Address - Country:US
Practice Address - Phone:404-702-6694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical