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General NPI Number Information
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NPI Number | 1104426220
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Entity Type | Individual
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Provider Name | MARCIA E JOHNSON PHD, LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 10/28/2020
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Last Update Date | 06/11/2024
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Provider Practice Location Address
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Address Line | 2700 NW 62ND ST
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City | FORT LAUDERDALE
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State | FL
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Zip | 33309-1744
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Country | US
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Telephone | 703-981-1078
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Fax |
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Provider Business Mailing Address
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Address Line | 8310 NW 47TH ST
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City | LAUDERHILL
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State | FL
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Zip | 33351-5535
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Country | US
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Telephone | 703-981-1078
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW22104
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LC200001248
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License Number State | DC
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 26341
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License Number State | MD
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