Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 37PC00635000 | NJ |
NPI | 1003393893 |
---|---|
Provider Name | Justine Johnson |
First Address | High Bridge, NJ 08829-1803 |
Second Address | Flemington, NJ 08822-1319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2018 |
Last Update Date | 09/01/2019 |