Individual
MRS. DEBRA EDITH DAVIS-JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
6206 W WIKIEUP LN, GLENDALE, AZ 85308-5207
(602) 290-4824
Mailing address
6206 W WIKIEUP LN, GLENDALE, AZ 85308-5207
(602) 290-4824
(866) 663-6564
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
3941
AZ
103TS0200X
School Psychologist
—
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
331706
—
AZ
01
—
Z132636
MEDICARE PTAN
AZ
Enumeration date
03/08/2007
Last updated
09/26/2012
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