Provider Demographics
NPI:1396174181
Name:JOHNSON, ERIC DARNELL (N/A)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:DARNELL
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:N/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2637 W BURREL AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-4511
Mailing Address - Country:US
Mailing Address - Phone:559-733-6307
Mailing Address - Fax:
Practice Address - Street 1:2637 W BURREL AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-4511
Practice Address - Country:US
Practice Address - Phone:559-733-6307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-02
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health