Provider Demographics
NPI:1376281501
Name:JOHNSON, ALIYYAH (MFT)
Entity Type:Individual
Prefix:
First Name:ALIYYAH
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 S 17TH ST STE 2200
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-6221
Mailing Address - Country:US
Mailing Address - Phone:484-489-0529
Mailing Address - Fax:
Practice Address - Street 1:255 S 17TH ST STE 2200
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-6221
Practice Address - Country:US
Practice Address - Phone:513-967-1706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-26
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist