| NPI | 1780136341 |
|---|---|
| Former Name | STEFANIE RAE JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC A12410) |
| Additional Taxonomies | 101YS0200X Counselor, School |
| Enumeration Date | 2016-10-31 |
| Last Update Date | 2016-10-31 |