Individual
DR. LARRY NORMAN JOHANNESSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD MSW LCSW MDIV
Contact information
Practice address
825 GUMBRANCH RD, SUITE 109, JACKSONVILLE, NC 28540
(910) 455-5551
(910) 938-2556
Mailing address
825 GUMBRANCH RD, SUITE 109, JACKSONVILLE, NC 28540
(910) 455-5551
(910) 938-2556
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
C003820
NC
Other
Enumeration date
02/15/2008
Last updated
02/15/2008
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