| NPI | 1770329807 |
|---|---|
| Former Name | KELSEY LAUREN JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ID CADC-5077) |
| Additional Taxonomies | 104100000X Social Worker (Licence: ID 4471144) |
| Enumeration Date | 2024-07-08 |
| Last Update Date | 2025-01-16 |