| NPI | 1538720826 |
|---|---|
| Former Name | CAMILLE LOUISE JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA C060939614) |
| Enumeration Date | 2019-06-26 |
| Last Update Date | 2019-06-26 |