Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | CG60918755 | WA |
NPI | 1003386236 |
---|---|
Provider Name | Desiree Brooke Johnson |
First Address | Spokane, WA 99202-1510 |
Second Address | Spokane, WA 99202-2211 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2018 |
Last Update Date | 30/11/2018 |