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Individual

MARVEA JOHNSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MED, ATR-BC, LPAT

Contact information

Practice address
8401 SHELBYVILLE RD STE 121, LOUISVILLE, KY 40222-5586
(502) 936-6546
Mailing address
95-1017 KUAULI ST APT 122, MILILANI, HI 96789-4935
(502) 294-1519

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
277581
KY
106S00000X
Behavior Technician
RBT-19-76062
KY
221700000X
Art Therapist
Primary
277581
KY

Other

Enumeration date
01/15/2019
Last updated
08/23/2024
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