Healthcare Provider Details

I. General information

NPI: 1578180816
Provider Name (Legal Business Name): ALICIA JOHNSTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2020
Last Update Date: 07/02/2020
Certification Date: 07/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7220 N 16TH ST STE G
PHOENIX AZ
85020-5253
US

IV. Provider business mailing address

1326 W MARSHALL AVE
PHOENIX AZ
85013-1740
US

V. Phone/Fax

Practice location:
  • Phone: 480-525-7284
  • Fax:
Mailing address:
  • Phone: 602-818-3262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: