Individual
MRS. SHANNON MOORE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LISAC, BA
Contact information
Practice address
12033 AGENCY RD STE 730, PARKER, AZ 85344-7718
(928) 669-3256
(928) 669-3252
Mailing address
12033 AGENCY RD STE 730, PARKER, AZ 85344-7718
(928) 669-3256
(928) 669-3252
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LISAC0725
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
893885
AHCCCS
AZ
Enumeration date
10/10/2006
Last updated
04/24/2013
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