Provider Demographics
NPI:1356198493
Name:JOHNSON KIRIMLIS, DAVID MATTHEW (LCADC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MATTHEW
Last Name:JOHNSON KIRIMLIS
Suffix:
Gender:M
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CIRCUIT CT
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-2812
Mailing Address - Country:US
Mailing Address - Phone:301-693-8486
Mailing Address - Fax:
Practice Address - Street 1:10411 MOTOR CITY DR STE 301
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1090
Practice Address - Country:US
Practice Address - Phone:240-622-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA3303101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)