Healthcare Provider Details

I. General information

NPI: 1205454741
Provider Name (Legal Business Name): CHRISTOPHER JOHNSON PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2020
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 MAIN ST.
HOLLIS CENTER ME
04042-0404
US

IV. Provider business mailing address

PO BOX 65
HOLLIS CENTER ME
04042-0065
US

V. Phone/Fax

Practice location:
  • Phone: 207-651-4113
  • Fax:
Mailing address:
  • Phone: 207-651-4113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS1612
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: