Individual
SHANE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3447 DERBY PL, NEW ORLEANS, LA 70119-2013
(504) 756-4028
Mailing address
3447 DERBY PL, NEW ORLEANS, LA 70119-2013
(504) 756-4028
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
11/29/2016
Last updated
11/29/2016
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