Provider Demographics
NPI:1659780823
Name:JOHNSON, JESSICA RACHELLE (LGSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RACHELLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10440 STANSFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-1279
Mailing Address - Country:US
Mailing Address - Phone:301-802-1465
Mailing Address - Fax:
Practice Address - Street 1:5901 UTAH AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-1616
Practice Address - Country:US
Practice Address - Phone:202-363-1333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG500808601041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool