Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | LICDC.162004 | OH |
N | 101YP1600X | Pastoral Counselor | ||
Y | 101YP2500X | Professional Counselor | C.1902406 | OH |
NPI | 1154873685 |
---|---|
Provider Name | Marlon Johnson |
First Address | Brooklyn, OH 44144-2724 |
Second Address | Brooklyn, OH 44144-2724 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2016 |
Last Update Date | 29/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0391321 | (05) | OH |