Individual
REGGIE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
177 EAST 122ND STREET, NY, NY 10035
(212) 360-7116
Mailing address
1030 PARK PL, BROOKLYN, NY 11213-1902
(347) 856-4002
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
24465
NY
Other
Enumeration date
04/17/2014
Last updated
04/17/2014
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