Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor | 293288 | FL |
NPI | 1003271891 |
---|---|
Provider Name | Shelley Johnson |
First Address | St Petersburg, FL 33713-7521 |
Second Address | St Petersburg, FL 33713-7521 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2015 |
Last Update Date | 21/12/2015 |