Provider Demographics
NPI:1346620028
Name:JOHNSON, MARLA (STUDENT COUNSELOR)
Entity Type:Individual
Prefix:DR
First Name:MARLA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:STUDENT COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 MEDICAL ARTS AVENUE N.E.
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE,
Mailing Address - State:NM
Mailing Address - Zip Code:87102
Mailing Address - Country:US
Mailing Address - Phone:505-842-5300
Mailing Address - Fax:505-765-1100
Practice Address - Street 1:1101 MEDICAL ARTS AVENUE N.E.
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE,
Practice Address - State:NM
Practice Address - Zip Code:87102
Practice Address - Country:US
Practice Address - Phone:505-842-5300
Practice Address - Fax:505-765-1100
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program