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Individual

DORETTA JOHNSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CASAC

Contact information

Practice address
1526 WALDEN AVE, SUITE 400, CHEEKTOWAGA, NY 14225-4965
(716) 895-7167
(716) 332-4488
Mailing address
1526 WALDEN AVE, SUITE 400, CHEEKTOWAGA, NY 14225-4965
(716) 895-7167
(716) 332-4488

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
02249145
NY
Enumeration date
08/29/2007
Last updated
08/29/2007
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