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General NPI Number Information
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NPI Number | 1699640649
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Entity Type | Individual
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Provider Name | MALIK JOHNSON
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Gender | Male
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Dates
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Enumeration Date | 10/09/2025
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 234 CEDAR LODGE RD
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City | THOMASVILLE
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State | NC
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Zip | 27360-6143
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Country | US
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Telephone | 336-474-2211
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Fax |
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Provider Business Mailing Address
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Address Line | 4755 COUNTRY CLUB RD APT 110B
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City | WINSTON SALEM
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State | NC
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Zip | 27104-3512
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Country | US
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Telephone | 704-713-0953
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | 000032995688
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License Number State | NC
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