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Provider Information for 1902571110


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SHILOH MARIE JOHNSON LMFT


Sex: Female

NPI: 1902571110
Last Updated: 2021-08-10
Certification Date: 2021-08-10

Details

NameValue
NPI1902571110
Enumeration Date2021-08-10
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
Mailing Address 6390 HARMONY GROVE RD
DOVER, PA 17315-2972
United States

Phone: 717-542-8079 | Fax:
 
Primary Practice Address 5661 FISH AND GAME RD
DOVER, PA 17315-2929
United States

Phone: 717-542-8079 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Other (non-Medicare)NoneNone
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 193400000X - Single Specialty Group
101YM0800X - Counselor - Mental Health
PAMF001287