Provider Demographics
NPI:1982249470
Name:JOHNSON, TIFFANY SHANTE (BSW)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:SHANTE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2314 BARTHOLOMEW ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70117-5018
Mailing Address - Country:US
Mailing Address - Phone:504-762-1414
Mailing Address - Fax:
Practice Address - Street 1:908 W JUDGE PEREZ DR STE C
Practice Address - Street 2:
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043-4773
Practice Address - Country:US
Practice Address - Phone:504-324-5298
Practice Address - Fax:504-556-0949
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-08
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13554171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator