Provider Demographics
NPI:1407233927
Name:JOHNSON, ANDREA COURTNEY (LCPC)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:COURTNEY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9913 CERVINE LN
Mailing Address - Street 2:APT 201
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-1933
Mailing Address - Country:US
Mailing Address - Phone:716-228-6609
Mailing Address - Fax:
Practice Address - Street 1:143 MAIN ST
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-1249
Practice Address - Country:US
Practice Address - Phone:443-712-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-05
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC7220101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health