Individual
PORSCHE T JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
17505 N 79TH AVE STE 410, GLENDALE, AZ 85308-8732
(623) 800-7980
Mailing address
2649 N 73RD DR, PHOENIX, AZ 85035-3253
(602) 314-0120
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LAC-16824
AZ
Other
Enumeration date
05/31/2018
Last updated
05/31/2018
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