Individual
SHELLY JOHNSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1 FREEDOM WAY, AUGUSTA, GA 30904-6258
(706) 733-0188
Mailing address
409 NORMANDY PL, AUGUSTA, GA 30909-2029
(706) 799-7262
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC013070
GA
Other
Enumeration date
09/01/2022
Last updated
09/01/2022
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