Provider Demographics
NPI:1417516592
Name:JOHN, ALISHIA FAITH (BSW, MED)
Entity Type:Individual
Prefix:
First Name:ALISHIA
Middle Name:FAITH
Last Name:JOHN
Suffix:
Gender:F
Credentials:BSW, MED
Other - Prefix:
Other - First Name:ALISHIA
Other - Middle Name:FAITH
Other - Last Name:THEIMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:176 EAST ST # B313
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-5468
Mailing Address - Country:US
Mailing Address - Phone:717-650-7230
Mailing Address - Fax:
Practice Address - Street 1:360 MERRIMACK ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-1740
Practice Address - Country:US
Practice Address - Phone:978-681-9684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program