Individual
REGINALD JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SCA-IT
Contact information
Practice address
3707 N RICHARDS ST, MILWAUKEE, WI 53212-1673
(414) 967-7006
(414) 967-7020
Mailing address
7314 W BURLEIGH ST, APT 3, MILWAUKEE, WI 53210-1082
(414) 447-7208
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
16415-130
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1780850594
—
WI
Enumeration date
12/02/2015
Last updated
12/02/2015
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