NPIMap

Organization Active NPI

Changing Generational Legacies,LLC

  • Professional Counselor
  • Largo, MD
National Provider Identifier
1598012155
Registry record updated Aug 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
LC3809 Issued in MD
Legal business name
CHANGING GENERATIONAL LEGACIES,LLC
Practice address
1401 Mercantile LN
Suite 200-Q
Largo, MD 20774-4301
Phone
(301) 322-4141
Fax
(301) 322-9199
NPI assigned
Aug 13, 2012
Last updated
Aug 13, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Debra Joyce Johnson, MS, LCPCNPI 1932403714
Title
Ceo, Founder
Phone
(301) 322-4141

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X LC3809 MD Primary

Addresses

Primary practice location

1401 Mercantile LN
Suite 200-Q
Largo, MD 20774-4301

Mailing address

1401 Mercantile LN
Suite 200-Q
Largo, MD 20774-4301
Phone (301) 322-4141

Other identifiers 1

IdentifierTypeStateIssuer
040457800MedicaidMD

National Provider Directory

National Provider Directory

Locations

1401 Mercantile Ln
Ste 200Q
Largo, MD 20774
Phone (301) 322-4141

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1344816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344816000000",
    "number": "1598012155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 MERCANTILE LN",
            "address_2": "SUITE 200-Q",
            "city": "LARGO",
            "state": "MD",
            "postal_code": "207744301",
            "telephone_number": "301-322-4141",
            "fax_number": "301-322-9199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 MERCANTILE LN",
            "address_2": "SUITE 200-Q",
            "city": "LARGO",
            "state": "MD",
            "postal_code": "207744301",
            "telephone_number": "301-322-4141",
            "fax_number": "301-322-9199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHANGING GENERATIONAL LEGACIES,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-13",
        "last_updated": "2012-08-13",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "JOYCE",
        "authorized_official_title_or_position": "CEO, FOUNDER",
        "authorized_official_telephone_number": "301-322-4141",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MS, LCPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MD",
            "license": "LC3809",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "040457800",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Largo, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.