Provider Demographics
NPI:1811762024
Name:JOHNSON, LEVI SIGHEE (MA, LCADC)
Entity type:Individual
Prefix:MR
First Name:LEVI
Middle Name:SIGHEE
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MA, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 MERTZ AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07205-1622
Mailing Address - Country:US
Mailing Address - Phone:201-471-1658
Mailing Address - Fax:
Practice Address - Street 1:70 MERTZ AVE
Practice Address - Street 2:
Practice Address - City:HILLSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07205-1622
Practice Address - Country:US
Practice Address - Phone:201-471-1658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00380400101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor