| NPI | 1982348744 |
|---|---|
| Former Name | STEPHANIE EILEEN JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA LH61035266) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH LICDC.161555) |
| 101YM0800X Counselor Mental Health (Licence: OH E.1800904) | |
| Enumeration Date | 2022-04-26 |
| Last Update Date | 2022-04-26 |