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NPI Code Detail

MEDICARE: DARRYL KEITH JOHNSON LCSW

MEDICARE: DARRYL KEITH JOHNSON LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker4506-CAR

General Provider Information

NPI Number : 1902630916
Entity Type Code : Individual
Provider Name (Legal Business Name) : DARRYL KEITH JOHNSON LCSW
Provider Business Mailing Address
First Line : 619 S OAK ST
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72205-5628
Country : US
Telephone Number : 501-247-2938
Fax Number :
Provider Business Practice Location Address
First Line : 1000 MAIN ST
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72202-3820
Country : US
Telephone Number : 501-257-4499
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2024
Last Update Date : 08/30/2024

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