Individual
MARIAH JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BA
Contact information
Practice address
1200 N 4TH ST, EFFINGHAM, IL 62401-3032
(217) 347-7179
Mailing address
1200 N 4TH ST, EFFINGHAM, IL 62401-3032
(217) 347-7179
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
370912882
—
IL
Enumeration date
10/23/2020
Last updated
10/23/2020
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