| NPI | 1194947259 |
|---|---|
| Former Name | JENNIE JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: TN 59654) |
| Additional Taxonomies | 261QM0850X Clinic/Center Adult Mental Health (Licence: NC 145081) |
| 103T00000X Psychologist (Licence: TN 59654) | |
| 103TP0016X Psychologist Prescribing (Medical) (Licence: NC 145081) | |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2025-06-09 |