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General NPI Number Information
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NPI Number | 1679747711
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Entity Type | Individual
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Provider Name | ANGELA MARIE JOHNS CADC
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Gender | Female
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Dates
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Enumeration Date | 04/19/2008
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Last Update Date | 04/19/2008
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Provider Practice Location Address
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Address Line | 555 FAIRVIEW DR # DRQ
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City | ROCHELLE
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State | IL
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Zip | 61068-2310
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Country | US
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Telephone | 815-502-9003
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Fax |
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Provider Business Mailing Address
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Address Line | 1614 MANESS CT
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City | SYCAMORE
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State | IL
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Zip | 60178-2910
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Country | US
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Telephone | 815-501-1707
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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 | 25871
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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