Individual
AMANDA MARIE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCDCII
Contact information
Practice address
1725 E 3RD ST, DAYTON, OH 45403-1850
(937) 387-6395
Mailing address
1899 LOWER BELLBROOK RD, XENIA, OH 45385-9310
(937) 613-9537
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
LCDCII.161326
OH
1041C0700X
Clinical Social Worker
Primary
I.2506279
OH
Other
Enumeration date
05/07/2018
Last updated
03/26/2025
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