Individual
MRS. TIA KAYSAUNDRA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA 1-19-38888
Contact information
Practice address
1753 MERIDEN WTBY TPKE, MILLDALE, CT 06467-6508
(203) 558-0367
Mailing address
425 BRIMFIELD RD, WETHERSFIELD, CT 06109-3205
(951) 813-7405
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1353
DEPARTMENT OF PUBLIC HEALTH
CT
Enumeration date
03/06/2018
Last updated
05/08/2023
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