Healthcare Provider Details

I. General information

NPI: 1407340185
Provider Name (Legal Business Name): KIMBERLY JOHNSON LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 12/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9520 BERGER RD STE 203
COLUMBIA MD
21046-1543
US

IV. Provider business mailing address

120 SISTER PIERRE DR STE 403
TOWSON MD
21204-7536
US

V. Phone/Fax

Practice location:
  • Phone: 410-290-6940
  • Fax: 443-279-0537
Mailing address:
  • Phone: 410-823-6408
  • Fax: 443-279-0537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC8733
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: