Individual
MARK LAMONT JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5626 CRESTHAVEN LN, TOLEDO, OH 43614-1241
(419) 810-4375
Mailing address
5626 CRESTHAVEN LN, TOLEDO, OH 43614-1241
(419) 810-4375
Taxonomy
Speciality
Code
Description
License number
State
103TM1800X
Intellectual & Developmental Disabilities Psychologist
Primary
8702313
OH
Other
Enumeration date
12/22/2020
Last updated
12/22/2020
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