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Individual

ITINA V JOHNSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
SAC-IT

Contact information

Practice address
1409 EMIL ST STE 100, MADISON, WI 53713-2311
(608) 283-6426
(608) 283-6374
Mailing address
151 E BADGER RD, MADISON, WI 53713-2725
(608) 250-2512

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
19618-130
WI
101YA0400X
Addiction (Substance Use Disorder) Counselor

Other

Enumeration date
07/21/2020
Last updated
03/14/2022
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