Provider Demographics
NPI:1366243685
Name:JOHNSON, RICK ALVIN
Entity type:Individual
Prefix:
First Name:RICK
Middle Name:ALVIN
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 1:148 SADDLEBROOK LN UNIT 611
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-7177
Mailing Address - Country:US
Mailing Address - Phone:859-653-7609
Mailing Address - Fax:
Practice Address - Street 1:148 SADDLEBROOK LN
Practice Address - Street 2:UNIT 611
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-7177
Practice Address - Country:US
Practice Address - Phone:859-653-7609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-22
Last Update Date:2025-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool