Provider Demographics
NPI:1073288023
Name:GEATHERS, JOHNNIE ROOSEVELT MAURICE (LSW)
Entity Type:Individual
Prefix:MR
First Name:JOHNNIE
Middle Name:ROOSEVELT MAURICE
Last Name:GEATHERS
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 FOX HILL DR APT T16
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-1670
Mailing Address - Country:US
Mailing Address - Phone:484-478-4971
Mailing Address - Fax:
Practice Address - Street 1:10 DUFF RD STE 201
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15235-3209
Practice Address - Country:US
Practice Address - Phone:412-871-5391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW138395104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker