Individual
GABRIELLE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
155 NE REVERE AVE STE 150, BEND, OR 97701-4147
(541) 617-4544
Mailing address
155 NE REVERE AVE STE 150, BEND, OR 97701-4147
(541) 617-4544
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
T-21-813
OR
106S00000X
Behavior Technician
—
OR
Other
Enumeration date
10/05/2020
Last updated
08/23/2021
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