Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | 101YP1600X-PASTORAL | MD |
NPI | 1326449919 |
---|---|
Provider Name | Shawn Johnson |
First Address | Snow Hill, MD 21863-4413 |
Second Address | Snow Hill, MD 21863-1330 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2014 |
Last Update Date | 15/08/2017 |