Individual
SHANIYA OCTAVIA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMBT
Contact information
Practice address
2912 LYNDHURST AVE, WINSTON SALEM, NC 27103-4006
(910) 360-3616
Mailing address
257 GLEN EAGLES DR, WINSTON SALEM, NC 27104-5329
(910) 360-3616
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
20175
NC
Other
Enumeration date
12/04/2023
Last updated
12/04/2023
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