Provider Demographics
NPI:1154861797
Name:JOHNSTON, TANGANEKA MONIQUE (LCSWA)
Entity type:Individual
Prefix:
First Name:TANGANEKA
Middle Name:MONIQUE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SHYAS CARES 714 S. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144
Mailing Address - Country:US
Mailing Address - Phone:704-603-8285
Mailing Address - Fax:704-353-7901
Practice Address - Street 1:SHYAS CARES 714 S. MAIN ST.
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144
Practice Address - Country:US
Practice Address - Phone:704-603-8285
Practice Address - Fax:704-353-7901
Is Sole Proprietor?:No
Enumeration Date:2017-03-01
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP011242101YM0800X
NCP0157791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC562546907Medicaid