Individual
NICOLE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1471 ELMWOOD AVE, CRANSTON, RI 02910-3849
(401) 724-8400
(401) 722-5280
Mailing address
520 HOPE ST, PROVIDENCE, RI 02906-2532
(401) 276-4531
(401) 722-5280
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
RI
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GH57134
—
RI
Enumeration date
11/17/2014
Last updated
12/13/2017
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