| NPI | 1528255585 |
|---|---|
| Former Name | TRACIE ERIN JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SD LPC-MH20366) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: SD LPC-MH20366) |
| Enumeration Date | 2007-10-03 |
| Last Update Date | 2023-05-15 |