Individual
MAXINE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA. LPCC
Contact information
Practice address
1100 GLENWOOD AVE, MINNEAPOLIS, MN 55405-1430
(612) 871-1454
Mailing address
8641 QUEEN AVE S, BLOOMINGTON, MN 55431-1903
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
—
—
Other
Enumeration date
11/19/2021
Last updated
10/28/2024
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