Individual
MIA C JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
375 W 84TH DR, MERRILLVILLE, IN 46410-6245
(260) 421-5000
(260) 421-5003
Mailing address
500 W MAIN ST, FORT WAYNE, IN 46802-1406
(260) 421-5000
(260) 421-5003
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39004056A
IN
Other
Enumeration date
10/04/2021
Last updated
10/04/2021
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