Female

Detrial W. Johnson PMFT

Marriage & Family Therapist in Tampa, FL(View on Map)

Full Name

Detrial Williams Johnson PMFT

NPI Number

1184939886

NPI Type

Individual Provider

Gender

Female

Enumeration Date

08/18/2010

Specialties

(Taxonomies)

Code

106H00000X
101Y00000X

Primary Taxonomy

Yes
No

Licenses

State

Florida

License Number

PMFT 130

Contact
Information

Purpose

Mailing
Location

Address

5707 N 22ND ST
5707 N 22ND ST

City

Tampa
Tampa

State

FL
FL

Postal Code

33610-4350
33610-4350

Country

US
US

Telephone Number

(813) 239-8506
(813) 239-8506

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 09/18/2015

Provider Address

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