Provider Demographics
NPI:1720359342
Name:JOHNSON, DARRELL (PHD, LPC)
Entity type:Individual
Prefix:
First Name:DARRELL
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 SAWMILL RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-3538
Mailing Address - Country:US
Mailing Address - Phone:614-717-9652
Mailing Address - Fax:614-717-9657
Practice Address - Street 1:5900 SAWMILL RD
Practice Address - Street 2:SUITE 210
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-3538
Practice Address - Country:US
Practice Address - Phone:614-717-9652
Practice Address - Fax:614-717-9657
Is Sole Proprietor?:No
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103T00000XBehavioral Health & Social Service ProvidersPsychologist