Healthcare Provider Details

I. General information

NPI: 1295663276
Provider Name (Legal Business Name): JOHNSON NJOROGE CNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 HAMILTON AVE
CENTRALIA WA
98531-2547
US

IV. Provider business mailing address

610 HAMILTON AVE
CENTRALIA WA
98531-2547
US

V. Phone/Fax

Practice location:
  • Phone: 360-807-4237
  • Fax: 360-807-4392
Mailing address:
  • Phone: 360-807-4237
  • Fax: 360-807-4392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number754579
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: