ENNIS SCOTT SAMUEL JOHNSON

SAN RAFAEL, CA
NPI1265138713
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date2023-02-06
Last Update Date2023-02-06
Business Address
ENNIS SCOTT SAMUEL JOHNSON
1601 2ND ST
SAN RAFAEL, CA 94901-2712
Phone number: 415-526-7810
Mailing Address
ENNIS SCOTT SAMUEL JOHNSON
1601 2ND ST
SAN RAFAEL, CA 94901-2712
Phone number: 415-526-7810
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