Healthcare Provider Details

I. General information

NPI: 1548865124
Provider Name (Legal Business Name): AYANNA AINA-JOHNSON BAKER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AYANNA AINA JOHNSON PH.D.

II. Dates (important events)

Enumeration Date: 12/02/2020
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

12010 LITTLE PATUXENT PKWY APT J
COLUMBIA MD
21044-4813
US

V. Phone/Fax

Practice location:
  • Phone: 888-884-2327
  • Fax:
Mailing address:
  • Phone: 816-645-9488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY200001717
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number40454
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: