Healthcare Provider Details

I. General information

NPI: 1780129148
Provider Name (Legal Business Name): LADONNA JOHNSON LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2016
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11275 SOUTHERN MARYLAND BLVD
DUNKIRK MD
20754-9546
US

IV. Provider business mailing address

11275 SOUTHERN MARYLAND BLVD
DUNKIRK MD
20754-9546
US

V. Phone/Fax

Practice location:
  • Phone: 406-788-4968
  • Fax:
Mailing address:
  • Phone: 406-788-4968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: