Organization
4C LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SAMUEL GARY JOHNSON LPC (LICENSED PROFESSIONAL COUNSELOR)
(814) 319-7217
Entity
Organization
Contact information
Practice address
114 ZION RD, CLARION, PA 16214-3254
(814) 319-7217
Mailing address
425 RON MCHENRY RD, KNOX, PA 16232-3009
(814) 797-0256
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
PC003785
PA
Other
Enumeration date
09/10/2015
Last updated
09/10/2015
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