Doctor Name: | MR. DAVID FLYNN JOHNSON |
NPI Number: | 1154674703 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | P.C.C.-S |
License Number: | E0003965 |
Business Practice Address: | 3095 Kettering Blvd Moraine, OH - 454391983 |
Business Phone Number: | 9379131901 |
Business Fax Number: | 9379131913 |
Mailing Address: | 3095 Kettering Blvd, MORAINE |
State: | OH |
Postal Code: | 454391983 |
Phone Number: | 9379131901 |
Fax Number: | 9379131913 |
NPI Enumeration Date: | 10/19/2012 |
NPI Last Update Date: | 10/19/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | E0003965 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |