Provider Demographics
NPI:1013367853
Name:JOHNSON, ROCHELLE MAXINE (LICDC, CRC)
Entity Type:Individual
Prefix:MS
First Name:ROCHELLE
Middle Name:MAXINE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LICDC, CRC
Other - Prefix:MRS
Other - First Name:ROCHELLE
Other - Middle Name:MAXINE
Other - Last Name:JOHNSON-COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICDC
Mailing Address - Street 1:1247 ROCKCRESS DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-9235
Mailing Address - Country:US
Mailing Address - Phone:419-297-7655
Mailing Address - Fax:419-726-7158
Practice Address - Street 1:2001 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-2241
Practice Address - Country:US
Practice Address - Phone:419-726-7577
Practice Address - Fax:419-726-7158
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-13
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH031000171M00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator