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General NPI Number Information
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NPI Number | 1760206775
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Entity Type | Individual
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Provider Name | NIKO DANTZLER-JOHNSON LPC
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Gender | Female
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Dates
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Enumeration Date | 11/15/2024
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Last Update Date | 11/15/2024
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Provider Practice Location Address
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Address Line | 615 E UPSAL ST APT 106
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City | PHILADELPHIA
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State | PA
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Zip | 19119-3937
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Country | US
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Telephone | 215-395-5238
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Fax |
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Provider Business Mailing Address
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Address Line | 615 E UPSAL ST APT 106
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City | PHILADELPHIA
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State | PA
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Zip | 19119-3937
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Country | US
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Telephone | 215-490-6404
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | PC017685
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License Number State | PA
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