MEDICARE: COURTNEY JOHNSON LGSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	LG200003051	DC

General Provider Information

NPI Number	:	1649111956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY JOHNSON LGSW

Provider Business Mailing Address
First Line	:	3401 E WEST HWY APT 546
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20782-2383
Country	:	US
Telephone Number	:	901-240-7526
Fax Number	:

Provider Business Practice Location Address
First Line	:	3401 E WEST HWY
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20782-2200
Country	:	US
Telephone Number	:	901-240-7526
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2026
Last Update Date	:	04/02/2026

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