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General NPI Number Information
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NPI Number | 1184060451
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Entity Type | Individual
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Provider Name | JEAN CAROL JOHNSON LCDC
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Gender | Female
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Dates
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Enumeration Date | 05/14/2013
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Last Update Date | 05/14/2013
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Provider Practice Location Address
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Address Line | 4408 DELWOOD LN
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City | PANAMA CITY
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State | FL
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Zip | 32408-7492
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Country | US
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Telephone | 850-636-7087
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Fax |
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Provider Business Mailing Address
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Address Line | 96 WHISPERING LAKE DR
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City | SANTA ROSA BEACH
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State | FL
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Zip | 32459-4286
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Country | US
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Telephone | 936-689-0914
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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 | 9929
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License Number State | TX
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