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General NPI Number Information
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NPI Number | 1124442603
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Entity Type | Individual
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Provider Name | TIFFANY DIANNE JOHNSON LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/05/2014
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 757 E LEWIS AND CLARK PKWY # 2031
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City | CLARKSVILLE
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State | IN
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Zip | 47129-2269
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Country | US
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Telephone | 502-536-8848
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Fax |
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Provider Business Mailing Address
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Address Line | 757 E LEWIS AND CLARK PKWY # 2031
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City | CLARKSVILLE
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State | IN
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Zip | 47129-2269
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Country | US
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Telephone | 502-536-8848
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 259524
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0009920292
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 34007645A
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License Number State | IN
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