Provider Demographics
NPI:1104426220
Name:JOHNSON, MARCIA E (PHD, LCSW-C)
Entity type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:E
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHD, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8310 NW 47TH ST
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33351-5535
Mailing Address - Country:US
Mailing Address - Phone:703-981-1078
Mailing Address - Fax:
Practice Address - Street 1:2700 NW 62ND ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-1744
Practice Address - Country:US
Practice Address - Phone:703-981-1078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FLSW221041041C0700X
DCLC2000012481041C0700X
MD263411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health