Provider Demographics
NPI:1720274632
Name:JOHNSON, JUDITH ANN X (MS, LCPC, LPC)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:ANN
Last Name:JOHNSON
Suffix:X
Gender:F
Credentials:MS, LCPC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10201 BALTIMORE AVE
Mailing Address - Street 2:APT # 1503
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-4216
Mailing Address - Country:US
Mailing Address - Phone:240-793-2269
Mailing Address - Fax:
Practice Address - Street 1:10201 BALTIMORE AVE
Practice Address - Street 2:APT # 1503
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-4216
Practice Address - Country:US
Practice Address - Phone:240-793-2269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2412101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional