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Individual

MICHELLE JOHNSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
22513 SE 61ST AVE, HAWTHORNE, FL 32640-3640
(352) 234-5738
Mailing address
22513 SE 61ST AVE, HAWTHORNE, FL 32640-3640
(352) 234-5738

Taxonomy

Speciality
Code
Description
License number
State
103TH0100X
Health Service Psychologist
Primary
236912
FL

Other

Enumeration date
09/24/2020
Last updated
09/24/2020
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