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General NPI Number Information
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NPI Number | 1073142014
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Entity Type | Individual
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Provider Name | DONNA JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 04/02/2020
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Last Update Date | 04/02/2020
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Provider Practice Location Address
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Address Line | 2644 30TH ST
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City | SANTA MONICA
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State | CA
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Zip | 90405-3060
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Country | US
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Telephone | 770-714-7605
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Fax |
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Provider Business Mailing Address
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Address Line | 475 E MAIN ST STE 110
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City | CARTERSVILLE
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State | GA
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Zip | 30121-3353
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Country | US
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Telephone | 770-714-7605
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0204
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License Number State | GA
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