Provider Demographics
NPI:1487203477
Name:JOHNSON, LARRY DARNELL (LMSW)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:DARNELL
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 5TH AVE SE STE 3000
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-2416
Mailing Address - Country:US
Mailing Address - Phone:319-286-4545
Mailing Address - Fax:319-368-3358
Practice Address - Street 1:1030 5TH AVE SE STE 3000
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-2416
Practice Address - Country:US
Practice Address - Phone:319-286-4545
Practice Address - Fax:319-368-3358
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0962831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical