Provider Demographics
NPI:1932262839
Name:JOHNSON, DAVID H (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:H
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 HINMAN AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-1362
Mailing Address - Country:US
Mailing Address - Phone:847-475-3017
Mailing Address - Fax:847-491-0398
Practice Address - Street 1:1599 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4367
Practice Address - Country:US
Practice Address - Phone:847-475-3017
Practice Address - Fax:847-491-0398
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health