Healthcare Provider Details

I. General information

NPI: 1497177943
Provider Name (Legal Business Name): CHRISTOPHER JOHNSON PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2014
Last Update Date: 01/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2806 EWING LN
CABOT AR
72023-2114
US

IV. Provider business mailing address

2806 EWING LN
CABOT AR
72023-2114
US

V. Phone/Fax

Practice location:
  • Phone: 501-859-3838
  • Fax:
Mailing address:
  • Phone: 501-859-3838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: