Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 101YP1600X | Pastoral Counselor |
NPI | 1073916870 |
---|---|
Provider Name | Tanisha Johnson |
First Address | Greenville, NC 27834-1129 |
Second Address | Greenville, NC 27834-1129 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2014 |
Last Update Date | 16/10/2014 |