Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003419904 |
---|---|
Provider Name | Lynn Johnson |
First Address | Los Angeles, CA 90043-4959 |
Second Address | Los Angeles, CA 90043-4959 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2020 |
Last Update Date | 21/11/2020 |