Provider Demographics
NPI:1831632033
Name:JOHNSON, CHRISTOPHER
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 300
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-0300
Mailing Address - Country:US
Mailing Address - Phone:425-282-5862
Mailing Address - Fax:425-282-5863
Practice Address - Street 1:200 MILL AVE S
Practice Address - Street 2:SUITE 10
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2175
Practice Address - Country:US
Practice Address - Phone:425-282-5682
Practice Address - Fax:425-282-5863
Is Sole Proprietor?:No
Enumeration Date:2016-11-21
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW606375591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical