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1093284382
JACK LEE JOHNSON
PASADENA, CA
NPI
1093284382
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2018-11-16
Last Update Date
2018-11-16
Business Address
JACK LEE JOHNSON
1680 NORTH FAIR OAKS
PASADENA, CA 91104
Phone number: 210-241-0481
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Mailing Address
JACK LEE JOHNSON
1680 N FAIR OAKS AVE
PASADENA, CA 91103-1642
Phone number: 626-798-0884
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