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Individual

DORETHA JOHNSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LMSW

Contact information

Practice address
60 LYNOAK CV, JACKSON, TN 38305-2909
(731) 668-7593
Mailing address
60 LYNOAK CV, JACKSON, TN 38305-2909

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
8927
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
20-3858944
CHILD AND FAMILY THERAPIST
TN
Enumeration date
02/19/2014
Last updated
03/06/2014
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