Johnson, Star Marie

Johnson, Star Marie is an individual health care provider with primary practice located at 748 14Th Ave , Longview WA 98632-2315. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Counselor, Other Service Providers / Peer Specialist. Other Service Providers / Peer Specialist is her primary health care specialty. Johnson, Star Marie can be contacted via phone (360) 200-5419.

Contact Information

Primary practice address
748 14Th Ave Longview WA 98632-2315
Phone: (360) 200-5419
Fax: (360) 200-6736
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Counselor 101Y00000X CO61000223 Washington
Other Service Providers / Peer Specialist 175T00000X CG60987591 Washington

Profile Details

NPI number 1235783366
LBN Legal business name Johnson, Star Marie
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 26th, 2019
Last updated Nov 13th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1235783366 NPPES
Washington MEDICAID 2140147

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