Individual
TITA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
709 MILL ST, CAMDEN, SC 29020-4738
(803) 432-6902
Mailing address
709 MILL ST, CAMDEN, SC 29020-4738
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1208155
SC
101YP2500X
Professional Counselor
Primary
5525
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
AD22KE
—
SC
Enumeration date
03/29/2013
Last updated
05/27/2013
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