Provider Demographics
NPI:1912752338
Name:JOHNSON, DAVID MARVIN (ED D, LMHC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:MARVIN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:ED D, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 BELMONT AVE E
Mailing Address - Street 2:C2
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102
Mailing Address - Country:US
Mailing Address - Phone:206-601-8992
Mailing Address - Fax:
Practice Address - Street 1:601 BELMONT AVE E
Practice Address - Street 2:C2
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102
Practice Address - Country:US
Practice Address - Phone:206-601-8992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00005481101YM0800X
WALH-00005481106H00000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist