Provider Demographics
NPI:1659423119
Name:JOHNSON, DANIEL (PHD, LCPC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PHD, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 OAK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT DESERT
Mailing Address - State:ME
Mailing Address - Zip Code:04660-6315
Mailing Address - Country:US
Mailing Address - Phone:207-460-2436
Mailing Address - Fax:
Practice Address - Street 1:20 OAK RIDGE RD
Practice Address - Street 2:
Practice Address - City:MOUNT DESERT
Practice Address - State:ME
Practice Address - Zip Code:04660-6315
Practice Address - Country:US
Practice Address - Phone:207-460-2436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC1217101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional