Provider Demographics
NPI:1124156831
Name:JOHNSON, TENISHA (LISW)
Entity type:Individual
Prefix:
First Name:TENISHA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4303 SEAHORSE LN
Mailing Address - Street 2:
Mailing Address - City:GROVEPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43125-8930
Mailing Address - Country:US
Mailing Address - Phone:614-361-7610
Mailing Address - Fax:614-413-1482
Practice Address - Street 1:4200 REGENT ST STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-6229
Practice Address - Country:US
Practice Address - Phone:614-450-2810
Practice Address - Fax:614-419-1482
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-9981104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker