Provider Demographics
NPI:1437384898
Name:JOHNSON, REGINA (DMIN, LGCAD, NCC)
Entity type:Individual
Prefix:DR
First Name:REGINA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DMIN, LGCAD, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 LONG TRAIL TER
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-7766
Mailing Address - Country:US
Mailing Address - Phone:910-546-0102
Mailing Address - Fax:
Practice Address - Street 1:311 LONG TRAIL TER
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-7766
Practice Address - Country:US
Practice Address - Phone:240-704-4002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YM0800X
MDLGADC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health