Provider Demographics
NPI:1427064286
Name:JOHNSON, RENEE M (LCSW)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:M
Other - Last Name:STOFKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8478 E. SPEEDWAY BLVD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-1730
Mailing Address - Country:US
Mailing Address - Phone:520-981-6988
Mailing Address - Fax:
Practice Address - Street 1:8478 E. SPEEDWAY BLVD
Practice Address - Street 2:SUITE 307
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-1730
Practice Address - Country:US
Practice Address - Phone:520-981-6988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-10145104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker