Individual
MRS. GINA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
530 NE GLEN OAK AVE, PEORIA, IL 61637-0001
(309) 655-2738
Mailing address
1926 COLT DR, WASHINGTON, IL 61571-9241
(309) 472-4609
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
180.007124
IL
Other
Enumeration date
05/20/2013
Last updated
05/20/2013
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