Provider Demographics
NPI:1396978003
Name:JOHNSON, DAVID (LMHC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1861 S PATRICK DR
Mailing Address - Street 2:BOX 166
Mailing Address - City:INDIAN HARBOUR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-4377
Mailing Address - Country:US
Mailing Address - Phone:321-693-4573
Mailing Address - Fax:321-610-8880
Practice Address - Street 1:1861 S PATRICK DR
Practice Address - Street 2:BOX 166
Practice Address - City:INDIAN HARBOUR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-4377
Practice Address - Country:US
Practice Address - Phone:321-693-4573
Practice Address - Fax:321-610-8880
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP 3095101YA0400X
FLMH 9197101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCAP 3095OtherCAP
FLMH9197OtherLMHC