Healthcare Provider Details

I. General information

NPI: 1407251507
Provider Name (Legal Business Name): DEANNE JOHNSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2014
Last Update Date: 10/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3029 MARTIN LUTHER KING JR AVE SE 3RD FL
WASHINGTON DC
20032-2506
US

IV. Provider business mailing address

9708 HELLINGLY PL
MONTGOMERY VILLAGE MD
20886-0580
US

V. Phone/Fax

Practice location:
  • Phone: 202-971-4051
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberPRC14490
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: