Individual
MRS. SHELLY NICOLE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA CAS LPC NCC
Contact information
Practice address
70 MARANATHA DRIVE, FAIRMONT, WV 26554
(304) 612-9499
(304) 278-7250
Mailing address
72 CHESTNUT STREET, RIVESVILLE, WV 26588
(304) 278-7250
(304) 278-7250
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
1739
WV
Other
Enumeration date
12/05/2006
Last updated
07/08/2007
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