Individual
CAROLYN M MARTIN-JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1499 SIXTH ST, INNOVATIVE COUNSELING, INC, GREEN BAY, WI 54304-2252
(920) 497-6161
(920) 498-0476
Mailing address
1499 SIXTH ST, INNOVATIVE COUNSELING, INC, GREEN BAY, WI 54304-2252
(920) 497-6161
(920) 498-0476
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
14160
WI
104100000X
Social Worker
Primary
4155-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40965400
—
WI
Enumeration date
01/09/2007
Last updated
03/08/2012
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