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General NPI Number Information
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NPI Number | 1801095617
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Entity Type | Individual
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Provider Name | CHARLIE WILL JOHNSON PH.D.
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Gender | Male
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Dates
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Enumeration Date | 07/12/2007
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Last Update Date | 04/19/2016
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Provider Practice Location Address
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Address Line | 5000 14TH ST NW
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City | WASHINGTON
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State | DC
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Zip | 20011-6926
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Country | US
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Telephone | 202-722-5555
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Fax |
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Provider Business Mailing Address
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Address Line | 5000 14TH ST NW
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City | WASHINGTON
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State | DC
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Zip | 20011-6926
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Country | US
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Telephone | 202-722-5555
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2900
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License Number State | MD
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