Most Relevant Information
Provider Data
| NPI Number: | 1003646324 |
| Provider Name: | MARIAH JOHNSON |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 08/02/2024 |
| Last Updated: | 08/02/2024 |
Provider Practice Location
112 CHILDRENS CIR
SANTA ROSA
CA
954096558
Practice Location Phone/Fax
| Phone: | 7075656350 |
| Fax: |
Provider Mailing Location
112 CHILDRENS CIR
SANTA ROSA
CA
954096558
Provider Mailing Phone/Fax
| Phone: | 7075656350 |
| Fax: |