Provider Demographics
NPI:1144352113
Name:JOHNSON, CINDY LOUISE (LCSW)
Entity type:Individual
Prefix:MS
First Name:CINDY
Middle Name:LOUISE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:CINDY
Other - Middle Name:LOUISE
Other - Last Name:JOHNSON-PEDEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:5034 THOROUGHBRED LN STE D
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4231
Mailing Address - Country:US
Mailing Address - Phone:615-507-2082
Mailing Address - Fax:
Practice Address - Street 1:5034 THOROUGHBRED LN STE D
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-4231
Practice Address - Country:US
Practice Address - Phone:615-507-2082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000010901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3151081OtherBCBS PIN