Provider Demographics
NPI:1902571110
Name:JOHNSON, SHILOH MARIE (LMFT)
Entity Type:Individual
Prefix:
First Name:SHILOH
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6390 HARMONY GROVE RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17315-2972
Mailing Address - Country:US
Mailing Address - Phone:717-542-8079
Mailing Address - Fax:
Practice Address - Street 1:5661 FISH AND GAME RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:PA
Practice Address - Zip Code:17315-2929
Practice Address - Country:US
Practice Address - Phone:717-542-8079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF001287101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE