| NPI | 1699827147 |
|---|---|
| Former Name | CALVIN CREGG JOHNSON |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 409231237) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2007-07-08 |