Provider Demographics
NPI:1811347842
Name:JOHNSON, LILLIE TASHEYA (MASSAGE THERAPIST)
Entity type:Individual
Prefix:MRS
First Name:LILLIE
Middle Name:TASHEYA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
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Mailing Address - Street 1:PO BOX 3165
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27515-3165
Mailing Address - Country:US
Mailing Address - Phone:919-503-7483
Mailing Address - Fax:919-629-4050
Practice Address - Street 1:14 CONSULTANT PL STE 250
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6320
Practice Address - Country:US
Practice Address - Phone:919-339-1835
Practice Address - Fax:919-629-4050
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-21
Last Update Date:2023-07-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY0277581225700000X
NC18059225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist