Individual
STACI JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ED.S., NCSP
Contact information
Practice address
66 SCHOOL ST, MONAVILLE, LOGAN, WV 25601-9605
(304) 792-2089
Mailing address
PO BOX 348, HOLDEN, WV 25625-0348
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
U8N131600211
WV
Other
Enumeration date
09/12/2016
Last updated
09/12/2016
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