Provider Demographics
NPI:1487126132
Name:JOHNSON, DA'KEISHA MOLIQUE (MA, LCPC-S)
Entity type:Individual
Prefix:MRS
First Name:DA'KEISHA
Middle Name:MOLIQUE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA, LCPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 FORBES BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-4823
Mailing Address - Country:US
Mailing Address - Phone:240-709-6557
Mailing Address - Fax:
Practice Address - Street 1:4200 FORBES BLVD STE 208
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4823
Practice Address - Country:US
Practice Address - Phone:240-709-6557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC8139101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional