Healthcare Provider Details

I. General information

NPI: 1669840021
Provider Name (Legal Business Name): SHARITA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 09/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6307 BARNWOOD DR
CLINTON MD
20735-2298
US

IV. Provider business mailing address

6307 BARNWOOD DR
CLINTON MD
20735-2298
US

V. Phone/Fax

Practice location:
  • Phone: 301-526-4159
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50079940
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: