Individual
MS. VIVIAN TINA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, NPP
Contact information
Practice address
538 RT 25A, SUITE 5, ROCKY POINT, NY 11778-9089
(631) 891-7316
(631) 821-3016
Mailing address
538 ROUTE 25A, SUITE 5, ROCKY POINT, NY 11778-9089
(631) 891-7316
(631) 821-3016
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
F400187-1
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
F-400187-1
NY
Other
Enumeration date
07/22/2009
Last updated
01/05/2012
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