Taij Mallory Johnson LPCA

NPI 1295169902 - Counselor - 101Y00000X

NPI Details
NPI 1295169902
Gender Male
Enumeration Date 08/29/2013
Last Updated 05/28/2015
Entity Type Individual
Active Over 3 years ago
Practice Location
1306 PADDOCK DR
STE E-100
RALEIGH NC, 27609-4873, US
Phone (919) 790-7775
Fax
Business Location
526 MCNEILL ST
LUMBERTON NC, 28358-5140, US
Phone (910) 474-8161
Fax
Toxanomy
Taxonomy Code 101Y00000X
License State North Carolina
License Number A10111
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According to our database, Mr. Taij Mallory Johnson LPCA NPI is 1295169902, taxonomy code is 101Y00000X and license number is A10111, license state is located at North Carolina. Taij Mallory Johnson LPCA physically located at 1306 Paddock Dr, Raleigh NC, 27609-4873. NPI Number Taij Mallory Johnson LPCA has the Individual type.

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1295169902 NPI number is provided on an as is basis without warranty of any kind. 1295169902 is maintained by the National Plan & Provider Enumeration System. The contents of Taij Mallory Johnson LPCA are for informational purposes only.