Provider Demographics
NPI:1831466838
Name:JOHNSON, MARIAH (MSW)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1467
Mailing Address - Street 2:
Mailing Address - City:SEWARD
Mailing Address - State:AK
Mailing Address - Zip Code:99664-1467
Mailing Address - Country:US
Mailing Address - Phone:907-224-3118
Mailing Address - Fax:907-224-5874
Practice Address - Street 1:221 THIRD AVE
Practice Address - Street 2:
Practice Address - City:SEWARD
Practice Address - State:AK
Practice Address - Zip Code:99664-1467
Practice Address - Country:US
Practice Address - Phone:907-224-3118
Practice Address - Fax:907-224-5874
Is Sole Proprietor?:No
Enumeration Date:2011-11-19
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker