Individual
LOWA GWEN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
11120 SOMERSET AVE, PRINCESS ANNE, MD 21853-2970
(410) 651-4200
Mailing address
2336 GODDARD PKWY, SALISBURY, MD 21801-1126
(410) 334-6961
(410) 334-6362
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LC4339
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
259147-000
MAGELLAN
MD
01
—
346646
MHN/TRICARE
MD
05
—
609550004
—
MD
01
—
7840093
AETNA
MD
01
—
R968
CAREFIRST
MD
Enumeration date
02/25/2012
Last updated
09/23/2016
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