Provider Demographics
NPI:1043195985
Name:JOHNSON, ALIVIA NICOLE
Entity type:Individual
Prefix:
First Name:ALIVIA
Middle Name:NICOLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 WINDY HILL CIR APT D
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-2091
Mailing Address - Country:US
Mailing Address - Phone:724-681-1729
Mailing Address - Fax:
Practice Address - Street 1:89 LAKEWIND CT
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27332-0612
Practice Address - Country:US
Practice Address - Phone:919-601-4785
Practice Address - Fax:910-356-9466
Is Sole Proprietor?:No
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25457394106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician