Provider Demographics
NPI:1922980283
Name:JOHNSON, NICKIE LONNEL
Entity type:Individual
Prefix:
First Name:NICKIE
Middle Name:LONNEL
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 DUDLEY WALK APT D
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45214-2583
Mailing Address - Country:US
Mailing Address - Phone:513-306-3276
Mailing Address - Fax:
Practice Address - Street 1:948 BANK ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45214
Practice Address - Country:US
Practice Address - Phone:513-306-3276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-25
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty