Individual
ANTHONY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
306 AIRPORT DRIVE, MONCKS CORNER, SC 29461
(843) 761-8272
Mailing address
306 AIRPORT DR, MONCKS CORNER, SC 29461-2629
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
173
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
571048948
—
SC
Enumeration date
12/17/2018
Last updated
12/17/2018
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