Provider Demographics
NPI:1013510486
Name:OLIVER-JOHNSON, DONTRAEY
Entity Type:Individual
Prefix:
First Name:DONTRAEY
Middle Name:
Last Name:OLIVER-JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 SW 117TH AVE APT 106
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3489
Mailing Address - Country:US
Mailing Address - Phone:305-942-8954
Mailing Address - Fax:
Practice Address - Street 1:1152 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-5000
Practice Address - Country:US
Practice Address - Phone:954-639-7345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor