Provider Demographics
NPI:1558709642
Name:JOHNSON, ISHMEAL TROKON SR (MMHC)
Entity Type:Individual
Prefix:MR
First Name:ISHMEAL
Middle Name:TROKON
Last Name:JOHNSON
Suffix:SR
Gender:M
Credentials:MMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7266 BRADFORD RD
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-3902
Mailing Address - Country:US
Mailing Address - Phone:610-497-7387
Mailing Address - Fax:610-497-7588
Practice Address - Street 1:2600 W 9TH ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-2040
Practice Address - Country:US
Practice Address - Phone:610-497-7387
Practice Address - Fax:610-497-7588
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical