Healthcare Provider Details

I. General information

NPI: 1265231757
Provider Name (Legal Business Name): ASHLEY JOHNSON LCADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2603 ELSINORE AVE
BALTIMORE MD
21216-2126
US

IV. Provider business mailing address

2603 ELSINORE AVE
BALTIMORE MD
21216-2126
US

V. Phone/Fax

Practice location:
  • Phone: 443-356-0257
  • Fax:
Mailing address:
  • Phone: 443-356-0257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCA3405
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: