Provider Demographics
NPI:1437971355
Name:JOHNSON, AMALIAH
Entity type:Individual
Prefix:
First Name:AMALIAH
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMALIAH
Other - Middle Name:
Other - Last Name:VARAZO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5776 SAINT AUGUSTINE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-8046
Mailing Address - Country:US
Mailing Address - Phone:904-676-9238
Mailing Address - Fax:
Practice Address - Street 1:2750 JOHN PROM BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-3921
Practice Address - Country:US
Practice Address - Phone:904-676-8238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health