Healthcare Provider Details

I. General information

NPI: 1538689997
Provider Name (Legal Business Name): EBONY JOHNSON PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2017
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 BUTLER PIKE STE 149
CONSHOHOCKEN PA
19428-1202
US

IV. Provider business mailing address

1950 BUTLER PIKE STE 149
CONSHOHOCKEN PA
19428-1202
US

V. Phone/Fax

Practice location:
  • Phone: 445-256-9252
  • 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: