Provider Demographics
NPI:1902978489
Name:JOHNSON, CHARLENE WINFIELD (MSSW)
Entity Type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:WINFIELD
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSSW
Other - Prefix:MISS
Other - First Name:CHARLENE
Other - Middle Name:
Other - Last Name:WINFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSSW
Mailing Address - Street 1:1848 WOODBURN DRIVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38127
Mailing Address - Country:US
Mailing Address - Phone:901-326-0549
Mailing Address - Fax:
Practice Address - Street 1:3810 WINCHESTER RD
Practice Address - Street 2:SOUTHEAST MENTAL HEALTH CENTER
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-9007
Practice Address - Country:US
Practice Address - Phone:901-369-1420
Practice Address - Fax:901-369-1433
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker