Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | 39000912A | IN |
N | 101YP1600X | Pastoral Counselor | 39000912A | IN |
N | 101YP2500X | Professional Counselor | 39000912A | IN |
N | 104100000X | Social Worker | 33003101A | IN |
NPI | 1164642294 |
---|---|
Provider Name | Denise Johnson |
First Address | Indianapolis, IN 46205-1956 |
Second Address | Indianapolis, IN 46205-1956 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
33003101A | SOCIAL WORKER LICENSE (01) | IN |
39000912A | MENTAL HEALTH COUNSELOR (01) | IN |
39000912A | PASTORAL CARE COUNSELOR (01) | IN |