Individual
TANISHA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A. R, MDIV.
Contact information
Practice address
110 WOODSIDE RD, GREENVILLE, NC 27834-1129
(252) 302-0700
Mailing address
110 WOODSIDE RD, GREENVILLE, NC 27834-1129
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YP1600X
Pastoral Counselor
Primary
—
—
Other
Enumeration date
10/07/2014
Last updated
10/16/2014
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