Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | LPC008173 | GA |
NPI | 1003214164 |
---|---|
Provider Name | Robin C Johnson |
First Address | Decatur, GA 30034-4920 |
Second Address | Decatur, GA 30034-4920 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2014 |
Last Update Date | 05/12/2014 |