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General NPI Number Information
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NPI Number | 1780540146
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Entity Type | Individual
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Provider Name | TIERAINIE C JOHNSON MS, MCAP
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Gender | Female
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Dates
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Enumeration Date | 12/30/2025
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 6028 CHESTER AVE STE 207
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City | JACKSONVILLE
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State | FL
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Zip | 32217-2285
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Country | US
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Telephone | 904-944-1269
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Fax | 904-659-8255
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Provider Business Mailing Address
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Address Line | 1650 MARGARET ST STE 302-320
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City | JACKSONVILLE
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State | FL
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Zip | 32204-3868
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Country | US
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Telephone | 904-944-1269
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Fax | 904-659-8255
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | MCAP.0101306
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License Number State | FL
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