Individual
CHARLES JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1320 HARVARD AVE, SHREVEPORT, LA 71103-2521
(318) 294-1654
Mailing address
2605 BETTY ST, SHREVEPORT, LA 71108-5553
(318) 216-3748
(318) 216-3786
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
12/13/2016
Last updated
12/13/2016
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