Individual
MR. DWIGHT JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
SAC
Contact information
Practice address
6815 N 68TH STREET, MILWAUKEE, WI 53216
(414) 466-3204
Mailing address
2462 N 5TH ST, MILWAUKEE, WI 53212-2704
(414) 466-3204
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
15616-131
WI
Other
Enumeration date
01/13/2011
Last updated
01/13/2011
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