Individual
NICOLE JOHNSON-SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2155 N STATE ROAD 9, LAGRANGE, IN 46761-8746
(260) 463-7144
Mailing address
PO BOX 191, LAGRANGE, IN 46761-0191
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39003603A
IN
Other
Enumeration date
08/16/2019
Last updated
08/16/2019
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