Provider Demographics
NPI:1780135301
Name:MAKONNEN, RAEJON LYNNE (LCPC)
Entity type:Individual
Prefix:MS
First Name:RAEJON
Middle Name:LYNNE
Last Name:MAKONNEN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MS
Other - First Name:RAEJON
Other - Middle Name:LYNNE
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2401 RESEARCH BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3246
Mailing Address - Country:US
Mailing Address - Phone:240-912-6025
Mailing Address - Fax:240-912-6130
Practice Address - Street 1:2401 RESEARCH BLVD STE 200
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3246
Practice Address - Country:US
Practice Address - Phone:240-912-6025
Practice Address - Fax:240-912-6130
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-18
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCPC #7426101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD114382400Medicaid