Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 0904011536 | VA |
NPI | 1003432949 |
---|---|
Provider Name | Michelle Jan Johnson |
First Address | Newport News, VA 23605-1134 |
Second Address | Newport News, VA 23605-1134 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2020 |
Last Update Date | 16/06/2020 |