| NPI | 1871949438 |
|---|---|
| Former Name | VIRGINIA DIANNE JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA cp 60520526) |
| Enumeration Date | 2016-05-12 |
| Last Update Date | 2019-04-09 |