Healthcare Provider Details

I. General information

NPI: 1356851182
Provider Name (Legal Business Name): JAMES DAVID JOHNSON LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2017
Last Update Date: 10/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 COURT AVE
MEMPHIS TN
38103-2813
US

IV. Provider business mailing address

2220 UNION AVE
MEMPHIS TN
38104-4315
US

V. Phone/Fax

Practice location:
  • Phone: 901-577-9400
  • Fax: 901-259-0675
Mailing address:
  • Phone: 901-567-3554
  • Fax: 901-567-3559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number224
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: