Individual
MRS. ALICIA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6670 CHIANTI AVE, LAKELAND, FL 33811-1828
(863) 670-3600
Mailing address
6670 CHIANTI AVE, LAKELAND, FL 33811-1828
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-20-142494
FL
222Q00000X
Developmental Therapist
—
—
Other
Enumeration date
11/30/2020
Last updated
02/07/2023
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