Individual
MATTHEW EVAN JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1443 HARTFORD AVE, JOHNSTON, RI 02919
(401) 273-8100
(401) 861-8696
Mailing address
117 ELLENFIELD ST STE 101, PROVIDENCE, RI 02905-4513
(401) 444-6779
(401) 444-6912
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CDP00775
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CDP00775
LCDP
RI
Enumeration date
03/11/2019
Last updated
03/20/2019
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