Provider Demographics
NPI:1689226011
Name:JOHNSON, CHANA M (LGPC)
Entity Type:Individual
Prefix:MRS
First Name:CHANA
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 LAUSANNE RD
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-4511
Mailing Address - Country:US
Mailing Address - Phone:410-496-4648
Mailing Address - Fax:
Practice Address - Street 1:9660 IRON LEAF TRL
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-5878
Practice Address - Country:US
Practice Address - Phone:301-490-1011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP9683101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional