Provider Demographics
NPI:1346471109
Name:JOHNSON, ALEISHA FAY (OWNER)
Entity Type:Individual
Prefix:MRS
First Name:ALEISHA
Middle Name:FAY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 ADDISON PL
Mailing Address - Street 2:
Mailing Address - City:GLENN HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:75154-8807
Mailing Address - Country:US
Mailing Address - Phone:972-679-6742
Mailing Address - Fax:469-272-5034
Practice Address - Street 1:1101 ADDISON PL
Practice Address - Street 2:
Practice Address - City:GLENN HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:75154-8807
Practice Address - Country:US
Practice Address - Phone:972-679-6742
Practice Address - Fax:469-272-5034
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator