Provider Demographics
NPI:1851268304
Name:JOHNSON, AMANDA
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
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 1:37 OLD SALEM RD
Mailing Address - Street 2:
Mailing Address - City:ECLECTIC
Mailing Address - State:AL
Mailing Address - Zip Code:36024-6411
Mailing Address - Country:US
Mailing Address - Phone:334-580-0088
Mailing Address - Fax:
Practice Address - Street 1:8149 OLD FEDERAL RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-8009
Practice Address - Country:US
Practice Address - Phone:205-506-2617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-20
Last Update Date:2025-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty