Provider Demographics
NPI:1326789413
Name:JOHNSON, OLIVIA (ADC-T)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:ADC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 11TH AVE NW STE 112
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-2739
Mailing Address - Country:US
Mailing Address - Phone:507-225-0400
Mailing Address - Fax:
Practice Address - Street 1:2005 3RD AVE SE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-4303
Practice Address - Country:US
Practice Address - Phone:507-440-7983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2649101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)