Healthcare Provider Details

I. General information

NPI: 1164157574
Provider Name (Legal Business Name): RASHANEEGON JOHNSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2022
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 S ORANGE AVE # 1204
SOUTH ORANGE NJ
07079-1702
US

IV. Provider business mailing address

28 GATES AVE
MONTCLAIR NJ
07042-3210
US

V. Phone/Fax

Practice location:
  • Phone: 862-234-0878
  • Fax:
Mailing address:
  • Phone: 862-234-0878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC01151300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: