Provider Demographics
NPI:1457106387
Name:JOHNSON, MAKIYAH TOMMI (BT)
Entity Type:Individual
Prefix:
First Name:MAKIYAH
Middle Name:TOMMI
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:BT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12998 HILL PINE RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28107-7834
Mailing Address - Country:US
Mailing Address - Phone:412-477-8578
Mailing Address - Fax:
Practice Address - Street 1:420 COPPERFIELD BLVD NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2404
Practice Address - Country:US
Practice Address - Phone:704-706-2200
Practice Address - Fax:980-334-2110
Is Sole Proprietor?:No
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician