Provider Demographics
NPI:1598268112
Name:JOHNSON, FELICIA LASHAWNA
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:LASHAWNA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44481-1017
Mailing Address - Country:US
Mailing Address - Phone:330-392-1124
Mailing Address - Fax:
Practice Address - Street 1:711 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44502-1039
Practice Address - Country:US
Practice Address - Phone:307-932-4873
Practice Address - Fax:330-743-5748
Is Sole Proprietor?:No
Enumeration Date:2018-03-09
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator