Provider Demographics
NPI:1801090550
Name:JOHNSON, ALICE A (MA)
Entity type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:A
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:A
Other - Last Name:NICHOLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:363 COURT ST STE 1
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-7306
Mailing Address - Country:US
Mailing Address - Phone:508-746-8004
Mailing Address - Fax:508-746-8099
Practice Address - Street 1:363 COURT ST STE 1
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-7306
Practice Address - Country:US
Practice Address - Phone:508-746-8004
Practice Address - Fax:508-746-8099
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6356101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health