Provider Demographics
NPI:1497207260
Name:JOHNSON, JEANNE MONIQUE (LCPC)
Entity Type:Individual
Prefix:MISS
First Name:JEANNE
Middle Name:MONIQUE
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 1:2008 GLENHAVEN PL
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-3614
Mailing Address - Country:US
Mailing Address - Phone:301-377-4024
Mailing Address - Fax:
Practice Address - Street 1:2008 GLENHAVEN PL
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-3614
Practice Address - Country:US
Practice Address - Phone:301-377-4024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC6022101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health