Provider Demographics
NPI:1194596783
Name:JOHNSON, TRACY SUNSHINE (SOCIAL WORKER)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:SUNSHINE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:OH
Mailing Address - Zip Code:44615-1347
Mailing Address - Country:US
Mailing Address - Phone:330-627-4313
Mailing Address - Fax:
Practice Address - Street 1:331 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:44615-1347
Practice Address - Country:US
Practice Address - Phone:330-627-4313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2310084104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker