| NPI | 1851033815 |
|---|---|
| Former Name | DESIREE RENE JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.183003) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.178507) |
| Enumeration Date | 2022-04-11 |
| Last Update Date | 2023-03-24 |