Provider Demographics
NPI:1770788697
Name:JOHNSON, DOUGLAS CHRISTIAN (PHD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:CHRISTIAN
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 1:8939 VILLA LA JOLLA DR
Mailing Address - Street 2:SUITE #230
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1732
Mailing Address - Country:US
Mailing Address - Phone:858-999-4287
Mailing Address - Fax:
Practice Address - Street 1:8939 VILLA LA JOLLA DR
Practice Address - Street 2:SUITE #230
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1732
Practice Address - Country:US
Practice Address - Phone:858-999-4287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21975103G00000X, 103TF0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical