Provider Demographics
NPI:1285960054
Name:JOHNSON, TISHIMA LAKEEDRA (LCSW)
Entity type:Individual
Prefix:MS
First Name:TISHIMA
Middle Name:LAKEEDRA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TISHIMA
Other - Middle Name:LAKEEDRA
Other - Last Name:RITTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1201 N.W 16TH STREET
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125
Mailing Address - Country:US
Mailing Address - Phone:305-575-7000
Mailing Address - Fax:305-418-2756
Practice Address - Street 1:1201 N.W 16TH STREET
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125
Practice Address - Country:US
Practice Address - Phone:305-575-7000
Practice Address - Fax:305-418-2756
Is Sole Proprietor?:No
Enumeration Date:2009-10-28
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
FLSW144361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker