Individual
MR. RAY C. JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, LPC, LISAC
Contact information
Practice address
5340 N 12TH ST, PHOENIX, AZ 85014-2903
(602) 274-0312
(602) 274-0312
Mailing address
5340 N 12TH ST, PHOENIX, AZ 85014-2903
(602) 274-0312
(602) 274-0312
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LISAC - 11495
AZ
101YP2500X
Professional Counselor
LPC - 10960
AZ
Other
Enumeration date
06/04/2010
Last updated
06/04/2010
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