| NPI | 1588121735 |
|---|---|
| Former Name | TORA NICOLE JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NC A14659) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 101YP2500X Counselor Professional (Licence: NC A14659) | |
| Enumeration Date | 2019-02-25 |
| Last Update Date | 2024-06-03 |