Provider Demographics
NPI:1437209400
Name:JOHNSON, RODERICK (CAC-AD, MSW)
Entity Type:Individual
Prefix:MR
First Name:RODERICK
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:CAC-AD, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19530 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-5200
Mailing Address - Country:US
Mailing Address - Phone:240-686-0707
Mailing Address - Fax:240-686-0711
Practice Address - Street 1:19530 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-5200
Practice Address - Country:US
Practice Address - Phone:240-686-0707
Practice Address - Fax:240-686-0711
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC1027101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)