Provider Demographics
NPI:1831890862
Name:JOHNSON, MICHAEL NATHANIEL
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:NATHANIEL
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 1:4005 20TH ST NE APT 4
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-3255
Mailing Address - Country:US
Mailing Address - Phone:813-541-2990
Mailing Address - Fax:
Practice Address - Street 1:4005 20TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-3255
Practice Address - Country:US
Practice Address - Phone:813-541-2990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician