Provider Demographics
NPI:1003294166
Name:JOHNSON, KRISTINA (PHD)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 BROAD ST
Mailing Address - Street 2:SUITE 422
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-1652
Mailing Address - Country:US
Mailing Address - Phone:412-741-8700
Mailing Address - Fax:412-741-8700
Practice Address - Street 1:701 BROAD ST
Practice Address - Street 2:SUITE 422
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-1652
Practice Address - Country:US
Practice Address - Phone:412-741-8700
Practice Address - Fax:412-741-8700
Is Sole Proprietor?:No
Enumeration Date:2015-05-09
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH002758101Y00000X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor