Provider Demographics
NPI:1679586655
Name:JOHNS, DAVID LEE (LMHC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LEE
Last Name:JOHNS
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 HOLLOWRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-9227
Mailing Address - Country:US
Mailing Address - Phone:407-970-8814
Mailing Address - Fax:888-386-7036
Practice Address - Street 1:465 SUMMERHAVEN DR
Practice Address - Street 2:SUITE A
Practice Address - City:DEBARY
Practice Address - State:FL
Practice Address - Zip Code:32713-5211
Practice Address - Country:US
Practice Address - Phone:407-970-8814
Practice Address - Fax:888-386-7037
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH1084101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7662891 00Medicaid