Provider Demographics
NPI:1194398933
Name:JOHNSON, JASON PAUL (LCPC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:PAUL
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14101 STURTEVANT RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20905-4446
Mailing Address - Country:US
Mailing Address - Phone:301-500-0406
Mailing Address - Fax:
Practice Address - Street 1:5901 MONTROSE RD APT N105
Practice Address - Street 2:
Practice Address - City:NORTH BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20852-4721
Practice Address - Country:US
Practice Address - Phone:301-500-0406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-20
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC11815101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health