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General NPI Number Information
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NPI Number | 1053770131
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Entity Type | Organization
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Legal Business Name | JENINE JOHNSON AND ASSOCIATES LLC
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Dates
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Enumeration Date | 02/17/2016
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Last Update Date | 02/17/2016
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Provider Practice Location Address
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Address Line | 7813 MONTGOMERY AVE 1ST FLOOR
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City | ELKINS PARK
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State | PA
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Zip | 19027-2608
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Country | US
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Telephone | 215-703-7865
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Fax |
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Provider Business Mailing Address
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Address Line | 7813 MONTGOMERY AVE 1ST FLOOR
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City | ELKINS PARK
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State | PA
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Zip | 19027-2608
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Country | US
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Telephone | 215-703-7865
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Fax |
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Authorized Official
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Title or Position | SOLE MBR
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Name | MS. JENINE JOHNSON
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Credential | LPC
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Telephone | 215-703-7865
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | PC007758
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License Number State | PA
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