Individual
CHARLES JOHNSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
1401 S 4TH ST, PHILA, PA 19147-5907
(215) 339-1079
Mailing address
432 N 6TH ST, PHILA, PA 19123-4004
(215) 925-2400
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS003915
PA
Other
Enumeration date
06/08/2006
Last updated
07/08/2007
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