| NPI | 1942292180 |
|---|---|
| Former Name | TARA MICHELLE JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 5335) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 10980) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2023-09-26 |