Individual
ANDRE LAMAR JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4131 UNIVERSITY BLVD S STE 15, JACKSONVILLE, FL 32216-4346
(904) 745-0067
(904) 745-1030
Mailing address
4131 UNIVERSITY BLVD S STE 15, JACKSONVILLE, FL 32216-4346
(904) 745-0067
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1256826
—
FL
Enumeration date
07/09/2019
Last updated
07/09/2019
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