Individual
SHIRLEY ANN JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OHIO LICDC-CSAND LSW
Contact information
Practice address
8658 N MAIN ST, DAYTON, OH 45415-1328
(937) 701-0030
(937) 387-9043
Mailing address
8658 N MAIN ST, DAYTON, OH 45415-1328
(937) 701-0030
(937) 387-9043
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
LICDC-CS 933508
OH
207QA0401X
Addiction Medicine (Family Medicine) Physician
LSW S0021857
OH
Other
Enumeration date
05/05/2016
Last updated
05/05/2016
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