Provider Demographics
NPI:1376219287
Name:JOHNSEN, MARYCYNTHIAGRACE (LCPC, MS , NCC)
Entity Type:Individual
Prefix:MRS
First Name:MARYCYNTHIAGRACE
Middle Name:
Last Name:JOHNSEN
Suffix:
Gender:F
Credentials:LCPC, MS , NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:M&M BEHAVIORAL HEALTH SOLUTIONS
Mailing Address - Street 2:1406 S. CRAIN HIGHWAY, STE. 104
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-3400
Mailing Address - Country:US
Mailing Address - Phone:410-766-6624
Mailing Address - Fax:
Practice Address - Street 1:7214 CALM SUNSET
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-3400
Practice Address - Country:US
Practice Address - Phone:848-391-3670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-19
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC10498101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health