| NPI | 1558800748 |
|---|---|
| Former Name | KELLEY ANNE JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 302823) |
| Enumeration Date | 2017-02-21 |
| Last Update Date | 2017-02-21 |