Provider Demographics
NPI:1467016345
Name:JOHNSON, DALAN MAURICE
Entity Type:Individual
Prefix:
First Name:DALAN
Middle Name:MAURICE
Last Name:JOHNSON
Suffix:
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 1:4554 TELHURST RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-3958
Mailing Address - Country:US
Mailing Address - Phone:323-309-2727
Mailing Address - Fax:
Practice Address - Street 1:23701 MILES RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-5473
Practice Address - Country:US
Practice Address - Phone:216-763-0800
Practice Address - Fax:216-763-0810
Is Sole Proprietor?:No
Enumeration Date:2019-04-26
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1903410104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker