Organization
CHANGING GENERATIONAL LEGACIES,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DEBRA JOYCE JOHNSON MS, LCPC (CEO, FOUNDER)
(301) 322-4141
Entity
Organization
Contact information
Practice address
1401 MERCANTILE LN, SUITE 200-Q, LARGO, MD 20774-4301
(301) 322-4141
(301) 322-9199
Mailing address
1401 MERCANTILE LN, SUITE 200-Q, LARGO, MD 20774-4301
(301) 322-4141
(301) 322-9199
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LC3809
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
040457800
—
MD
Enumeration date
08/13/2012
Last updated
08/13/2012
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