JOHNNY EARL HENDERSON

SAN RAFAEL, CA
NPI1154207843
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: CA  16180)
Enumeration Date2025-08-15
Last Update Date2025-08-15
Business Address
JOHNNY EARL HENDERSON
134 PICNIC AVE
SAN RAFAEL, CA 94901-5003
Phone number: 415-410-9388
Mailing Address
JOHNNY EARL HENDERSON
134 PICNIC AVE
SAN RAFAEL, CA 94901-5003
Phone number: 415-410-9388
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