Provider Demographics
NPI:1841903689
Name:JOHNSON, DALLANN ALEXANDER (NCC)
Entity type:Individual
Prefix:
First Name:DALLANN
Middle Name:ALEXANDER
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 S GRAHAM ST APT 8
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15232-1269
Mailing Address - Country:US
Mailing Address - Phone:703-477-5006
Mailing Address - Fax:
Practice Address - Street 1:1505 E CARSON ST FL 3
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15203-1701
Practice Address - Country:US
Practice Address - Phone:412-289-2326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-26
Last Update Date:2022-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1650775OtherNBCC - NCC CERTIFICATION