Individual
THERESA TARA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
25 JAMES ONEILL ST, SOUTH BOSTON, MA 02127-4504
(617) 534-9500
(617) 419-1706
Mailing address
1010 MASSACHUSETTS AVE, BOSTON, MA 02118-2600
(617) 534-4222
(857) 288-2305
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
01/19/2024
Last updated
01/19/2024
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