Individual
REAGAN JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
119 COUNTRY LN, CHARLESTON, WV 25312-6003
(304) 989-0052
Mailing address
PO BOX 128, POCA, WV 25159-0128
(304) 769-8077
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
08/30/2023
Last updated
08/30/2023
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