Provider Demographics
NPI:1538826219
Name:JOHNSON, THOMAISINA (LIFE COACH/CLERGY)
Entity type:Individual
Prefix:
First Name:THOMAISINA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LIFE COACH/CLERGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 PHILADELPHIA AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:SHILLINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19607-2798
Mailing Address - Country:US
Mailing Address - Phone:484-540-0851
Mailing Address - Fax:
Practice Address - Street 1:18 PHILADELPHIA AVE APT 4
Practice Address - Street 2:
Practice Address - City:SHILLINGTON
Practice Address - State:PA
Practice Address - Zip Code:19607-2798
Practice Address - Country:US
Practice Address - Phone:484-540-0851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA374U00000X
101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No374U00000XNursing Service Related ProvidersHome Health Aide