Individual
MS. TINA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
799 COVE PKWY, COTTONWOOD, AZ 86326-4683
(701) 261-9685
Mailing address
270 S DESPERADO DR, COTTONWOOD, AZ 86326-7356
(701) 261-9685
(701) 346-1100
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-17813
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1454874
—
ND
Enumeration date
04/25/2006
Last updated
05/11/2020
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