Provider Demographics
NPI:1710601083
Name:STENBERG-JOHNSON, NICHA
Entity Type:Individual
Prefix:
First Name:NICHA
Middle Name:
Last Name:STENBERG-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 1:16132 CHURCHVIEW DR STE 201
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-3850
Mailing Address - Country:US
Mailing Address - Phone:904-732-8255
Mailing Address - Fax:
Practice Address - Street 1:16132 CHURCHVIEW DR STE 201
Practice Address - Street 2:
Practice Address - City:LITHIA
Practice Address - State:FL
Practice Address - Zip Code:33547-3850
Practice Address - Country:US
Practice Address - Phone:904-732-8255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-30
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)