Provider Demographics
NPI:1740996008
Name:JOHNSON, TOMEKA LOUVENIA (MBA, CTRS, CARSS)
Entity type:Individual
Prefix:
First Name:TOMEKA
Middle Name:LOUVENIA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MBA, CTRS, CARSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8848 SWEET FLAG LOOP
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-5156
Mailing Address - Country:US
Mailing Address - Phone:601-472-1388
Mailing Address - Fax:
Practice Address - Street 1:8848 SWEET FLAG LOOP
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-5156
Practice Address - Country:US
Practice Address - Phone:601-472-1388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS54600225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist