Healthcare Provider Details

I. General information

NPI: 1730891706
Provider Name (Legal Business Name): NICOLE JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2022
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1714 LINCOLN WAY
WHITE OAK PA
15131-1716
US

IV. Provider business mailing address

1714 LINCOLN WAY
WHITE OAK PA
15131-1716
US

V. Phone/Fax

Practice location:
  • Phone: 724-420-7143
  • Fax:
Mailing address:
  • Phone: 724-271-8136
  • 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: