Healthcare Provider Details

I. General information

NPI: 1013367853
Provider Name (Legal Business Name): ROCHELLE MAXINE JOHNSON LICDC, CRC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ROCHELLE MAXINE JOHNSON-COOK LICDC

II. Dates (important events)

Enumeration Date: 06/13/2016
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 E CENTRAL AVE
TOLEDO OH
43608-2241
US

IV. Provider business mailing address

1247 ROCKCRESS DR
TOLEDO OH
43615-9235
US

V. Phone/Fax

Practice location:
  • Phone: 419-726-7577
  • Fax: 419-726-7158
Mailing address:
  • Phone: 419-297-7655
  • Fax: 419-726-7158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number031000
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number031000
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: