Individual
DERRICK JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4606 LEE ST, ALEXANDRIA, LA 71302-3235
(318) 441-1105
(318) 441-2251
Mailing address
4606 LEE ST, ALEXANDRIA, LA 71302-3235
(318) 441-1105
(318) 441-2251
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1023382033
—
LA
Enumeration date
04/11/2017
Last updated
04/11/2017
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