Individual
DR. JACOBA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
255 S 17TH ST, PHILADELPHIA, PA 19103-6231
(267) 403-3035
Mailing address
2413 SPRUCE ST, PHILADELPHIA, PA 19103-5526
(202) 669-7626
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PS019061
PA
Other
Enumeration date
09/23/2020
Last updated
11/15/2022
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