Healthcare Provider Details

I. General information

NPI: 1003534264
Provider Name (Legal Business Name): DAVID JOHNSON LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5321 VIA MARISOL
LOS ANGELES CA
90042-4883
US

IV. Provider business mailing address

5321 VIA MARISOL
LOS ANGELES CA
90042-4883
US

V. Phone/Fax

Practice location:
  • Phone: 312-964-4649
  • Fax:
Mailing address:
  • Phone: 312-964-4649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number15441
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: