| NPI | 1497001093 |
|---|---|
| Former Name | KELLY LYNN JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NV 00677-C) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NV 01275) |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2012-08-01 |
| Last Update Date | 2024-09-17 |