Provider Demographics
NPI:1669941399
Name:JOHNSON, CHRISTINA DEGRAFT (LCPC)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:DEGRAFT
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:DEGRAFT-JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCPC
Mailing Address - Street 1:405 S COLLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21231-2735
Mailing Address - Country:US
Mailing Address - Phone:240-418-4515
Mailing Address - Fax:
Practice Address - Street 1:2700 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21227-3115
Practice Address - Country:US
Practice Address - Phone:667-600-2632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC8734101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health