Provider Demographics
NPI:1710016498
Name:JOHNSON, DOUGLAS PAUL (PHD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:PAUL
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5721 CUTLER HEALTH CTR
Mailing Address - Street 2:
Mailing Address - City:ORONO
Mailing Address - State:ME
Mailing Address - Zip Code:04469-5721
Mailing Address - Country:US
Mailing Address - Phone:207-581-1392
Mailing Address - Fax:207-581-4975
Practice Address - Street 1:5721 CUTLER HEALTH CTR
Practice Address - Street 2:
Practice Address - City:ORONO
Practice Address - State:ME
Practice Address - Zip Code:04469-5721
Practice Address - Country:US
Practice Address - Phone:207-581-1392
Practice Address - Fax:207-581-4975
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME825103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling