Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | BH002758 | PA |
NPI | 1003294166 |
---|---|
Provider Name | Kristina Johnson |
First Address | Sewickley, PA 15143-1652 |
Second Address | Sewickley, PA 15143-1652 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2015 |
Last Update Date | 02/07/2015 |