| NPI | 1831179563 |
|---|---|
| Former Name | ANGIE D. JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IA 00853) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IA 040075) |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2023-09-11 |