Provider Demographics
NPI:1912044595
Name:JOHNSON, DIONE NICOLE (PHD)
Entity Type:Individual
Prefix:
First Name:DIONE
Middle Name:NICOLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 MEDLEY LN
Mailing Address - Street 2:
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-3123
Mailing Address - Country:US
Mailing Address - Phone:240-625-7674
Mailing Address - Fax:
Practice Address - Street 1:24 MEDLEY LN
Practice Address - Street 2:
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-3123
Practice Address - Country:US
Practice Address - Phone:240-625-7674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017364103TC0700X
CA52387106H00000X
NJ35SI00519OOO103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist