Provider Information for 1649048067
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GLENDA JOHNSON LCMHC
Sex: Female
NPI: 1649048067
Last Updated: 2024-07-19
Certification Date: 2024-07-19
Certification Date: 2024-07-19
Details
| Name | Value | ||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1649048067 | ||||||||||||||||
| Enumeration Date | 2023-12-14 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | YES | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | 520 PARK VILLAGE LN ALABASTER, AL 35007-7763 United States Phone: 832-633-1921 | Fax: | ||||||||||||||||
| Primary Practice Address | 200 OFFICE PARK DR MOUNTAIN BRK, AL 35223-2418 United States Phone: 659-212-6916 | Fax: | ||||||||||||||||
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