Provider Demographics
NPI:1881025278
Name:JOHNSON, ANTHONY LEE (PHD, LCSW, BCD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:LEE
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PHD, LCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22732 TATE ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20871-6394
Mailing Address - Country:US
Mailing Address - Phone:469-831-4603
Mailing Address - Fax:
Practice Address - Street 1:2307 MARTIN LUTHER KING JR AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-5813
Practice Address - Country:US
Practice Address - Phone:202-525-4855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-10
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD226611041C0700X
TX387741041C0700X
LA106381041C0700X
AZ138041041C0700X
MSC81031041C0700X
DCLC500813411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical