Individual
MRS. KATRENA FAYE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SUPPORTED LIVING COA
Contact information
Practice address
4500 CRUSADERS WAY, GREENWOOD, FL 32443-6907
(850) 209-0195
(850) 592-8195
Mailing address
4500 CRUSADERS WAY, GREENWOOD, FL 32443-6907
(850) 209-0195
(850) 592-8195
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
FL
Other
Enumeration date
08/09/2006
Last updated
07/08/2007
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