Doctor Name: | HENRIETTA JOHNSON |
NPI Number: | 1861698292 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 1835 N Gilmore Avenue Peace River Center Lakeland, FL - 33805 |
Business Phone Number: | 8632483300 |
Business Fax Number: | 8634132719 |
Mailing Address: | Po Box 1559, Peace River Center BARTOW |
State: | FL |
Postal Code: | 338311559 |
Phone Number: | 8635190575 |
Fax Number: | 8635190728 |
NPI Enumeration Date: | 06/22/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |