NPI | 1801179098 |
---|---|
Former Name | TERRI RAE JOHNSON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW019335) |
Additional Taxonomies | 104100000X Social Worker (Licence: PA SW128152) |
Enumeration Date | 2011-09-23 |
Last Update Date | 2017-01-25 |