Provider Demographics
NPI:1851935357
Name:JOHNSON, JOHN C II (LCPC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:JOHNSON
Suffix:II
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10104 SENATE DR STE 214
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-4393
Mailing Address - Country:US
Mailing Address - Phone:301-531-4025
Mailing Address - Fax:
Practice Address - Street 1:10104 SENATE DR STE 214
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4393
Practice Address - Country:US
Practice Address - Phone:301-531-4025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-29
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC10437101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD38-3876389Medicaid