Provider Demographics
NPI:1295853794
Name:JOHNSON, BRUCE C (CADS, CEAP, MS)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:C
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:CADS, CEAP, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5171 W WOODMILL DR
Mailing Address - Street 2:SUITE 9
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-4067
Mailing Address - Country:US
Mailing Address - Phone:302-999-9812
Mailing Address - Fax:302-999-9820
Practice Address - Street 1:5171 W WOODMILL DR
Practice Address - Street 2:SUITE 9
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-4067
Practice Address - Country:US
Practice Address - Phone:302-999-9812
Practice Address - Fax:302-999-9820
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)