Doctor Name: | MRS. MARINA GORDULA JOHNSON |
NPI Number: | 1134568801 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCAS-A, LCSW-A |
License Number: | |
Business Practice Address: | 112 E. Elwood Avenue Raeford, NC - 28376 |
Business Phone Number: | 9108481924 |
Business Fax Number: | 9108481928 |
Mailing Address: | 112 E. Elwood Avenue, RAEFORD |
State: | NC |
Postal Code: | 28376 |
Phone Number: | 9108481924 |
Fax Number: | 9108481928 |
NPI Enumeration Date: | 06/17/2013 |
NPI Last Update Date: | 06/17/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |