Healthcare Provider Details

I. General information

NPI: 1710275839
Provider Name (Legal Business Name): JEMEL ERIKA JOHNSON-SMITH LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2011
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10630 LITTLE PATUXENT PKWY STE 224D
COLUMBIA MD
21044-3264
US

IV. Provider business mailing address

7424 CATTERICK CT
WINDSOR MILL MD
21244-5600
US

V. Phone/Fax

Practice location:
  • Phone: 443-787-2894
  • Fax:
Mailing address:
  • Phone: 443-787-2894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number15202
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number15202
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number15202
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number15202
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number15202
License Number StateMD
# 6
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15202
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: