Provider Demographics
NPI:1245643071
Name:JOHNS, NICOLE ALYSON
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ALYSON
Last Name:JOHNS
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 1:195 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-3607
Mailing Address - Country:US
Mailing Address - Phone:843-509-7655
Mailing Address - Fax:
Practice Address - Street 1:195 EAST AVE
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-3607
Practice Address - Country:US
Practice Address - Phone:843-509-7655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-10
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6871101YM0800X
NY007879-01101YM0800X
NYP92878101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health