Provider Demographics
NPI:1932403714
Name:JOHNSON, DEBRA JOYCE (MS, NCC, LCPC)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:JOYCE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS, NCC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 MERCANTILE LN
Mailing Address - Street 2:SUITE 200-Q
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-4301
Mailing Address - Country:US
Mailing Address - Phone:443-418-8614
Mailing Address - Fax:301-322-9199
Practice Address - Street 1:1401 MERCANTILE LN
Practice Address - Street 2:SUITE 200-Q
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-4301
Practice Address - Country:US
Practice Address - Phone:443-418-8614
Practice Address - Fax:301-322-9199
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-07
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3809101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD040457800Medicaid
MDAC04OtherCAREFIRST