Healthcare Provider Details

I. General information

NPI: 1194657585
Provider Name (Legal Business Name): ABRAM D JOHNSON MHCA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 NORTHUP WAY STE 130
BELLEVUE WA
98004-1419
US

IV. Provider business mailing address

PO BOX 51004
SEATTLE WA
98115-1004
US

V. Phone/Fax

Practice location:
  • Phone: 206-316-2375
  • Fax: 203-316-2310
Mailing address:
  • Phone: 206-316-2375
  • Fax: 203-316-2310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC70103152
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: