Provider Demographics
NPI:1043215304
Name:JOHNSON, RHONDA D (MSSW)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:D
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 HIGHLAND TER
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-2420
Mailing Address - Country:US
Mailing Address - Phone:615-848-0065
Mailing Address - Fax:615-848-0862
Practice Address - Street 1:511 HIGHLAND TER
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-2420
Practice Address - Country:US
Practice Address - Phone:615-848-0065
Practice Address - Fax:615-848-0862
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000033751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN083461OtherVALUE OPTIONS
TN136994000OtherMAGELLAN MIS#
TN5681091OtherAETNA
TN3025262OtherBLUE CROSS BLUE SHIELD
TN3697476Medicare ID - Type Unspecified
TN136994000OtherMAGELLAN MIS#