Provider Demographics
NPI:1639505746
Name:JOHNSON, ROSALYN I (EDD, LMHC)
Entity Type:Individual
Prefix:DR
First Name:ROSALYN
Middle Name:I
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:EDD, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:797 TEAGUE TRL
Mailing Address - Street 2:APT 10-303
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-3110
Mailing Address - Country:US
Mailing Address - Phone:352-315-7800
Mailing Address - Fax:352-360-6582
Practice Address - Street 1:2020 TALLEY RD
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-3426
Practice Address - Country:US
Practice Address - Phone:352-315-7800
Practice Address - Fax:352-360-6582
Is Sole Proprietor?:No
Enumeration Date:2013-09-20
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 12044101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor