Organization
DAVENPORT DIAGNOSTIC AND TREATMENT CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KIMBERLY C JOHNSON PSYD (PSYCOLOGIST)
(972) 850-0720
Entity
Organization
Contact information
Practice address
14275 MIDWAY RD, SUITE 220, ADDISON, TX 75001-3614
(972) 850-0720
Mailing address
14275 MIDWAY RD, SUITE 220, ADDISON, TX 75001-3614
(972) 850-0720
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
32578
TX
103TS0200X
School Psychologist
32698
TX
Other
Enumeration date
01/14/2009
Last updated
01/14/2009
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