Individual
CHANELLE M JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
217 GATEWAY LN, COLUMBIA, SC 29210-7452
(803) 840-8832
Mailing address
217 GATEWAY LN, COLUMBIA, SC 29210-7452
(803) 840-8832
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
219278
SC
Other
Enumeration date
09/19/2016
Last updated
09/19/2016
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