Provider Demographics
NPI:1366056913
Name:JOHNSON, ALETA MICHELLE (HAIR LOSS SPECIALIST)
Entity type:Individual
Prefix:MS
First Name:ALETA
Middle Name:MICHELLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9431 ARBORVIEW CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269
Mailing Address - Country:US
Mailing Address - Phone:980-458-5377
Mailing Address - Fax:
Practice Address - Street 1:9711 DAVID TAYLOR DR.
Practice Address - Street 2:STE. 145
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262
Practice Address - Country:US
Practice Address - Phone:980-458-5377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC930931744P3200X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No1744P3200XOther Service ProvidersSpecialistProsthetics Case Management