Provider Demographics
NPI:1649072703
Name:JOHNSON, ISABELLA D (RBT)
Entity type:Individual
Prefix:
First Name:ISABELLA
Middle Name:D
Last Name:JOHNSON
Suffix:
Gender:
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 HABERSHAM RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-9073
Mailing Address - Country:US
Mailing Address - Phone:706-469-2261
Mailing Address - Fax:
Practice Address - Street 1:3633 WHEELER RD STE 320
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6552
Practice Address - Country:US
Practice Address - Phone:706-817-4149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-25-419577106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician