Individual
STACY LEE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1307 S 11TH ST, TACOMA, WA 98405-3644
(253) 682-2180
Mailing address
PO BOX 685, SPANAWAY, WA 98387-0685
(253) 538-2323
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CP60741726
WA
252Y00000X
Early Intervention Provider Agency
CO60237827
WA
Other
Enumeration date
08/17/2016
Last updated
08/25/2020
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