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General NPI Number Information
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NPI Number | 1003773235
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Entity Type | Individual
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Provider Name | DAVID T JOHNSON SUDRC2
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Gender | Male
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Dates
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Enumeration Date | 01/08/2026
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Last Update Date | 01/08/2026
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Provider Practice Location Address
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Address Line | 58945 BUSINESS CENTER DR
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City | YUCCA VALLEY
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State | CA
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Zip | 92284-7307
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Country | US
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Telephone | 760-610-6466
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Fax | 760-594-9998
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Provider Business Mailing Address
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Address Line | 16248 VICTOR ST
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City | VICTORVILLE
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State | CA
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Zip | 92395-3934
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Country | US
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Telephone | 760-243-7151
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 24393
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License Number State | CA
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