Provider Demographics
NPI:1124753637
Name:JOHNSON, ANDREA ANGELA (MA)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:ANGELA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3848 YORK AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410-1161
Mailing Address - Country:US
Mailing Address - Phone:763-350-4939
Mailing Address - Fax:
Practice Address - Street 1:3848 YORK AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55410-1161
Practice Address - Country:US
Practice Address - Phone:763-350-4939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health