Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | ||
N | 101YP1600X | Pastoral Counselor |
NPI | 1356956668 |
---|---|
Provider Name | Ms. Gwendoly Denise Johnson |
First Address | Durham, NC 27707-1177 |
Second Address | Durham, NC 27707-1177 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2020 |
Last Update Date | 14/09/2020 |