Individual
AVERY CENESE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
110 COLISEUM XING, STE 138, HAMPTON, VA 23666-5971
(757) 210-4233
Mailing address
44 TWIN LAKES CIR, HAMPTON, VA 23666-2352
(757) 646-2834
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1962069526
BOSS INNER CHILD COUNSELING
VA
Enumeration date
04/18/2022
Last updated
04/18/2022
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