| NPI | 1700400769 |
|---|---|
| Other Name | JACKIE L JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 23-05-20274) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR 24-QMHA-II-000217) |
| Enumeration Date | 2020-06-04 |
| Last Update Date | 2024-03-11 |