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Individual

EBONY SHANTE JOHNSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
170 BENNETT ST, BRIDGEPORT, CT 06605-2901
(203) 864-5013
Mailing address
140 TEXAS AVE, BRIDGEPORT, CT 06610-1852
(203) 864-5013

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary

Other

Enumeration date
02/18/2022
Last updated
02/18/2022
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