Provider Demographics
NPI:1912653049
Name:JOHNSON, DONALD SCOTT (SUDPT)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:SCOTT
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:SUDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6240 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-5412
Mailing Address - Country:US
Mailing Address - Phone:360-714-8180
Mailing Address - Fax:
Practice Address - Street 1:1221 FRASER ST STE E101
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-5844
Practice Address - Country:US
Practice Address - Phone:360-714-8180
Practice Address - Fax:360-715-2915
Is Sole Proprietor?:No
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60862475101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)