Provider Demographics
NPI:1417031865
Name:JOHNSON, WARD D (MFT)
Entity Type:Individual
Prefix:
First Name:WARD
Middle Name:D
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 MARLBOROUGH DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-2020
Mailing Address - Country:US
Mailing Address - Phone:619-584-1725
Mailing Address - Fax:619-584-4697
Practice Address - Street 1:45 N COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-8908
Practice Address - Country:US
Practice Address - Phone:619-584-1725
Practice Address - Fax:619-584-4697
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT12245106H00000X
NC1208106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist