Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | LPC007997 | GA |
NPI | 1003289992 |
---|---|
Provider Name | Candace Johnson |
First Address | Alpharetta, GA 30009-2070 |
Second Address | Alpharetta, GA 30009-2070 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2015 |
Last Update Date | 02/11/2015 |