Provider Demographics
NPI:1447905740
Name:JOHNSON, LONAYE (RBT)
Entity type:Individual
Prefix:
First Name:LONAYE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12205 SHADOW RUN BLVD
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-6336
Mailing Address - Country:US
Mailing Address - Phone:813-368-2655
Mailing Address - Fax:
Practice Address - Street 1:10817 BLOOMINGDALE AVE
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-3616
Practice Address - Country:US
Practice Address - Phone:813-436-3538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB759984106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician