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Individual

MRS. DOMINI MARIE JOHNSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.S., LCPC, NCC,CDVP

Contact information

Practice address
16417 EVANS AVE, SOUTH HOLLAND, IL 60473-2350
(708) 362-3916
Mailing address
16417 EVANS AVENUE, SOUTH HOLLAND, IL 60473
(708) 362-3916

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
180004580
IL

Other

Enumeration date
11/22/2009
Last updated
04/11/2012
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