Provider Demographics
NPI:1851614960
Name:JOHNSON, DANITA JO (MA)
Entity Type:Individual
Prefix:MS
First Name:DANITA
Middle Name:JO
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 LOCH LOMOND LN
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-1729
Mailing Address - Country:US
Mailing Address - Phone:719-787-8148
Mailing Address - Fax:
Practice Address - Street 1:7 LOCH LOMOND LN
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-1729
Practice Address - Country:US
Practice Address - Phone:719-778-1484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor