Provider Demographics
NPI:1427358506
Name:JOHNSON, MARQUIS DELAFAYETTE SR
Entity Type:Individual
Prefix:MR
First Name:MARQUIS
Middle Name:DELAFAYETTE
Last Name:JOHNSON
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5537 ROARING WIND CT
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-0743
Mailing Address - Country:US
Mailing Address - Phone:702-927-3364
Mailing Address - Fax:702-522-0310
Practice Address - Street 1:5537 ROARING WIND CT
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-0743
Practice Address - Country:US
Practice Address - Phone:702-927-3364
Practice Address - Fax:702-522-0310
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-23
Last Update Date:2010-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health