Individual
VANESSA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW, LSAA
Contact information
Practice address
US HWY 491 NORTH, SHIPROCK, NM 87420
(505) 368-6001
(505) 368-6114
Mailing address
PO BOX 160, SHIPROCK, NM 87420-0160
(505) 368-6001
(505) 368-6114
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
CSA0203271
NM
101YA0400X
Addiction (Substance Use Disorder) Counselor
CSA0203271
NM
104100000X
Social Worker
Primary
SWB-2022-0054
NM
Other
Enumeration date
07/10/2019
Last updated
12/09/2022
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