NPI | 1083177604 |
---|---|
Former Name | ANNIKA MICHELE JOHNSON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: OR 3425) |
Additional Taxonomies | 101Y00000X Counselor (Licence: WA MC60969986) |
101YM0800X Counselor, Mental Health (Licence: WA MC60969986) | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2019-04-10 |
Last Update Date | 2022-05-09 |