Provider Demographics
NPI:1154017861
Name:JOHNSON, GINA MARIE (MA, LPCMH, NCC)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:
Credentials:MA, LPCMH, NCC
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:MARIE
Other - Last Name:MOSCHITTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:749 WHITEBRIAR RD
Mailing Address - Street 2:
Mailing Address - City:HOCKESSIN
Mailing Address - State:DE
Mailing Address - Zip Code:19707-9345
Mailing Address - Country:US
Mailing Address - Phone:267-229-9129
Mailing Address - Fax:
Practice Address - Street 1:1200 N FRENCH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-3239
Practice Address - Country:US
Practice Address - Phone:302-652-3948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-14
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC0011825101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health