Provider Demographics
NPI:1942722970
Name:JOHNSON, RON C (LGPC, NCC)
Entity Type:Individual
Prefix:MR
First Name:RON
Middle Name:C
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LGPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14208 SCHOOL LN
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-2829
Mailing Address - Country:US
Mailing Address - Phone:540-419-1800
Mailing Address - Fax:
Practice Address - Street 1:11680 DOOLITTLE DR STE 103
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3802
Practice Address - Country:US
Practice Address - Phone:240-607-2756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLGPC00256101YM0800X
MDLGP7904101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health