| NPI | 1255991477 |
|---|---|
| Former Name | LAURA ELIZABETH JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: RI CDP00692) |
| Enumeration Date | 2019-06-19 |
| Last Update Date | 2019-06-19 |