Provider Demographics
NPI:1386124980
Name:JOHNSON, TOMMIE MARIA
Entity type:Individual
Prefix:
First Name:TOMMIE
Middle Name:MARIA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4531 READING RD FL 2
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-1229
Mailing Address - Country:US
Mailing Address - Phone:513-961-3292
Mailing Address - Fax:513-961-3349
Practice Address - Street 1:4531 READING RD FL 2
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-1229
Practice Address - Country:US
Practice Address - Phone:513-961-3292
Practice Address - Fax:513-961-3349
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101Y00000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH101Y00000XMedicaid