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Individual
JACQUELYN L JOHNSON
Active
Individual
JACQUELYN L JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADC II/QMHA-II
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
23-05-20274
OR
101YM0800X
Mental Health Counselor
24-QMHA-II-000217
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500780897
—
OR
05
—
500783424
—
OR
Enumeration date
06/04/2020
Last updated
03/11/2024
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