Provider Demographics
NPI:1982124178
Name:JOHNSON, FABRIAN LAMONT JR (MS)
Entity Type:Individual
Prefix:MR
First Name:FABRIAN
Middle Name:LAMONT
Last Name:JOHNSON
Suffix:JR
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6007 BELDEN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-3233
Mailing Address - Country:US
Mailing Address - Phone:856-397-9187
Mailing Address - Fax:
Practice Address - Street 1:6007 BELDEN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-3233
Practice Address - Country:US
Practice Address - Phone:856-397-9187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health