Provider Demographics
NPI:1912660788
Name:JOHNSON, SHAWNNA (MS, LGPC)
Entity Type:Individual
Prefix:MRS
First Name:SHAWNNA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS, LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2457 BEAVER CROSSING RD
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:21040-1327
Mailing Address - Country:US
Mailing Address - Phone:410-414-3328
Mailing Address - Fax:
Practice Address - Street 1:529 EDMUND ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-3429
Practice Address - Country:US
Practice Address - Phone:443-414-3328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP12041101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health