Individual
EMILY JEANNE FORNWALT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCMHC-S
Contact information
Practice address
614 W PINE ST, JOHNSON CITY, TN 37604-6608
(423) 281-4089
Mailing address
614 W PINE ST, JOHNSON CITY, TN 37604-6608
(423) 281-4089
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
S6459
NC
Other
Enumeration date
03/08/2007
Last updated
05/01/2024
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