Provider Demographics
NPI:1568789543
Name:JOHANSON, ALLISON FAEHL (LCSW, LAC)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:FAEHL
Last Name:JOHANSON
Suffix:
Gender:F
Credentials:LCSW, LAC
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:NICOLE
Other - Last Name:FAEHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:609 W LITTLETON BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-2352
Mailing Address - Country:US
Mailing Address - Phone:720-556-8885
Mailing Address - Fax:
Practice Address - Street 1:609 W LITTLETON BLVD STE 201
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-2352
Practice Address - Country:US
Practice Address - Phone:720-556-8885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-29
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO270101YA0400X
CO21121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)