Individual
KEITH MICHAEL JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
C.A.S.A.C.
Contact information
Practice address
16812 127TH AVE, APT # 7E, JAMAICA, NY 11434-3152
(347) 466-0698
Mailing address
16812 127TH AVE, APT # 7E, JAMAICA, NY 11434-3152
(347) 466-0698
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12777
C.A.S.A.C.
NY
Enumeration date
10/25/2012
Last updated
10/25/2012
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