Individual
JACQUELINE ANITA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1233 MAIN ST, HOLYOKE, MA 01040-5381
(413) 493-2082
(413) 539-2436
Mailing address
1233 MAIN ST, HOLYOKE, MA 01040-5381
(413) 493-2082
(413) 539-2436
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1629062906
—
MA
Enumeration date
09/18/2012
Last updated
09/18/2012
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