Healthcare Provider Details

I. General information

NPI: 1629932686
Provider Name (Legal Business Name): AVA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 ELM ST
KINGSTON MA
02364-1906
US

IV. Provider business mailing address

4 ELM ST
KINGSTON MA
02364-1906
US

V. Phone/Fax

Practice location:
  • Phone: 781-585-4221
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: