Individual
JOHNWICK NATHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6736 W CARSON RD, LAVEEN, AZ 85339-7024
(860) 938-6845
Mailing address
3950 W CHANDLER BLVD APT 3049, CHANDLER, AZ 85226-2662
(860) 938-6845
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
251S00000X
Community/Behavioral Health Agency
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
08/23/2018
Last updated
08/23/2018
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