Individual
AMANDA ROXANNE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CHA-III
Contact information
Practice address
110 MAIN STREET, AMBLER, AK 99786-0110
(907) 445-2129
(907) 445-2179
Mailing address
80 BACK STREET, SHUNGNAK, AK 99773
(907) 437-2138
(907) 437-2139
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
172V00000X
Community Health Worker
11-1129-II
AK
Other
Enumeration date
12/14/2011
Last updated
12/10/2014
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