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Individual

JEREMIAH JOHNSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
7430 ROYALE LN, RIVERDALE, GA 30296-7223
(757) 681-6803
Mailing address
7430 ROYALE LN, RIVERDALE, GA 30296-7223
(757) 681-6803

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary

Other

Enumeration date
11/21/2019
Last updated
11/21/2019
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