Provider Demographics
NPI:1205467206
Name:JOHNSON, ROBERT L (MC, MCAP, CMHP, CST)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MC, MCAP, CMHP, CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3908 GLACIER BAY PL
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:MD
Mailing Address - Zip Code:20695-3328
Mailing Address - Country:US
Mailing Address - Phone:561-239-1822
Mailing Address - Fax:
Practice Address - Street 1:3908 GLACIER BAY PL
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695-3328
Practice Address - Country:US
Practice Address - Phone:561-239-1822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-28
Last Update Date:2024-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ101Y00000X
FL101YA0400X, 101YM0800X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health