Provider Demographics
NPI:1033137419
Name:JOHNSON-GLEATON, LYNN (LPC)
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:
Last Name:JOHNSON-GLEATON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7203 PITTVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19126-1526
Mailing Address - Country:US
Mailing Address - Phone:215-713-0590
Mailing Address - Fax:215-713-0590
Practice Address - Street 1:7203 PITTVILLE AVE
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19126-1526
Practice Address - Country:US
Practice Address - Phone:215-713-0590
Practice Address - Fax:215-713-0590
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004118101Y00000X, 101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health