Provider Demographics
NPI:1750996880
Name:JOHNSON, TAMELA (ADC-IP)
Entity type:Individual
Prefix:
First Name:TAMELA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:ADC-IP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1439 THUNDERBOLT DRIVE WALTERBORO, SC 29488
Mailing Address - Street 2:P.O. BOX 1037
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29488
Mailing Address - Country:US
Mailing Address - Phone:843-538-4343
Mailing Address - Fax:
Practice Address - Street 1:1439 THUNDERBOLT DRIVE WALTERBORO, SC 29488
Practice Address - Street 2:1439 THUNDERBOLT DRIVE WALTERBORO, SC 29488
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488
Practice Address - Country:US
Practice Address - Phone:843-538-4343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)