Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003341181 |
---|---|
Provider Name | Enrico J Johnson |
First Address | Bridgeville, PA 15017-1833 |
Second Address | Bridgeville, PA 15017-1833 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2017 |
Last Update Date | 26/04/2017 |