Healthcare Provider Details

I. General information

NPI: 1720359342
Provider Name (Legal Business Name): DARRELL JOHNSON PHD, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2012
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 SAWMILL RD SUITE 210
DUBLIN OH
43017-3538
US

IV. Provider business mailing address

5900 SAWMILL RD SUITE 210
DUBLIN OH
43017-3538
US

V. Phone/Fax

Practice location:
  • Phone: 614-717-9652
  • Fax: 614-717-9657
Mailing address:
  • Phone: 614-717-9652
  • Fax: 614-717-9657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: