Provider Demographics
NPI:1942344684
Name:JOHNSON, SCOTT DAVIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:DAVIS
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 1:22 W PADONIA RD
Mailing Address - Street 2:SUITE C-252
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-2226
Mailing Address - Country:US
Mailing Address - Phone:410-561-1114
Mailing Address - Fax:
Practice Address - Street 1:22 W PADONIA RD
Practice Address - Street 2:SUITE C252
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-2226
Practice Address - Country:US
Practice Address - Phone:410-561-1114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1547101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional