MEDICARE: TIERAINIE C JOHNSON MS, MCAP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	MCAP.0101306	FL

General Provider Information

NPI Number	:	1780540146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIERAINIE C JOHNSON MS, MCAP

Provider Business Mailing Address
First Line	:	1650 MARGARET ST STE 302-320
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-3868
Country	:	US
Telephone Number	:	904-944-1269
Fax Number	:	904-659-8255

Provider Business Practice Location Address
First Line	:	6028 CHESTER AVE STE 207
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2285
Country	:	US
Telephone Number	:	904-944-1269
Fax Number	:	904-659-8255

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2025
Last Update Date	:	12/30/2025

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