1902978489 NPI number — MS. CHARLENE WINFIELD JOHNSON MSSW

Table of content: MS. CHARLENE WINFIELD JOHNSON MSSW (NPI 1902978489)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902978489 NPI number — MS. CHARLENE WINFIELD JOHNSON MSSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
CHARLENE
Provider Middle Name:
WINFIELD
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WINFIELD
Provider Other First Name:
CHARLENE
Provider Other Middle Name:
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1902978489
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1848 WOODBURN DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-326-0549
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3810 WINCHESTER RD
Provider Second Line Business Practice Location Address:
SOUTHEAST MENTAL HEALTH CENTER
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38118-9007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-369-1420
Provider Business Practice Location Address Fax Number:
901-369-1433
Provider Enumeration Date:
11/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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