Individual
KADEEM DAVID JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
35 MARK DRIVE, WALLINGFORD, CT 06492
(203) 265-0981
Mailing address
2 PARK PL APT 18E, HARTFORD, CT 06106-5016
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
03/26/2019
Last updated
07/10/2023
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