Provider Demographics
NPI:1497047245
Name:JOHNSON, DARREN W (LAC, MAC)
Entity Type:Individual
Prefix:
First Name:DARREN
Middle Name:W
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LAC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9627 HAWICK LN
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-3119
Mailing Address - Country:US
Mailing Address - Phone:301-801-2732
Mailing Address - Fax:
Practice Address - Street 1:3720 FARRAGUT AVE STE 105
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-2110
Practice Address - Country:US
Practice Address - Phone:301-592-9355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-12
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01786171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist