Provider Demographics
NPI:1770891582
Name:JOHNSON-NELSON, ALEXIS K (IMFT)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:K
Last Name:JOHNSON-NELSON
Suffix:
Gender:F
Credentials:IMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 GOVERNORS SQ STE A
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-4861
Mailing Address - Country:US
Mailing Address - Phone:678-364-1300
Mailing Address - Fax:678-364-1352
Practice Address - Street 1:145 GOVERNORS SQ STE A
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215-4861
Practice Address - Country:US
Practice Address - Phone:678-364-1300
Practice Address - Fax:678-364-1352
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF-1200001106H00000X
GAMFT001257106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist