Provider Demographics
NPI:1649548876
Name:PAMELA H. JOHNSON, LCSW, PC
Entity type:Organization
Organization Name:PAMELA H. JOHNSON, LCSW, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:HEATH
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:423-870-0085
Mailing Address - Street 1:5211 HWY 153
Mailing Address - Street 2:SUITE C
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-4950
Mailing Address - Country:US
Mailing Address - Phone:423-870-0085
Mailing Address - Fax:423-870-3411
Practice Address - Street 1:5211 HWY 153
Practice Address - Street 2:SUITE C
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-4950
Practice Address - Country:US
Practice Address - Phone:423-870-0085
Practice Address - Fax:423-870-3411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNIP0000541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3690364Medicare UPIN