Healthcare Provider Details

I. General information

NPI: 1881732535
Provider Name (Legal Business Name): RONALD M. JOHNSON LCDC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 E 2ND ST STE A
AUSTIN TX
78702-4491
US

IV. Provider business mailing address

1430 COLLIER ST
AUSTIN TX
78704-2911
US

V. Phone/Fax

Practice location:
  • Phone: 512-804-3390
  • Fax: 512-472-5857
Mailing address:
  • Phone: 512-445-7787
  • Fax: 512-440-4059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1018
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: