Provider Demographics
NPI:1699573949
Name:JOHNSON, CRYSTAL LATONDYA (LPC)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:LATONDYA
Last Name:JOHNSON
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:757 E MAIN ST APT D207
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-7010
Mailing Address - Country:US
Mailing Address - Phone:267-903-6315
Mailing Address - Fax:
Practice Address - Street 1:411 W CHELTENHAM AVE
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-3201
Practice Address - Country:US
Practice Address - Phone:267-903-6315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC018255101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional