Provider Demographics
NPI:1982441333
Name:JOHNSON, AMANDA CHIANA (MS)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:CHIANA
Last Name:JOHNSON
Suffix:
Gender:X
Credentials:MS
Other - Prefix:MR
Other - First Name:DEACON
Other - Middle Name:MAXWELL
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:405 HEISTER RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-1558
Mailing Address - Country:US
Mailing Address - Phone:717-579-0766
Mailing Address - Fax:
Practice Address - Street 1:405 HEISTER RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-1558
Practice Address - Country:US
Practice Address - Phone:717-579-0766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health