Healthcare Provider Details

I. General information

NPI: 1285760330
Provider Name (Legal Business Name): CAROLE ELIZABETH JOHNSON RN, CS, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROLE ELIZABETH JOHNSON-TUKES RN, CS, LICSW

II. Dates (important events)

Enumeration Date: 02/25/2007
Last Update Date: 08/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 E DEER PARK DR SUITE 101B
GAITHERSBURG MD
20877-2000
US

IV. Provider business mailing address

9905 MAPLE LEAF DR
MONTGOMERY VILLAGE MD
20886-1133
US

V. Phone/Fax

Practice location:
  • Phone: 301-881-4884
  • Fax: 301-740-3577
Mailing address:
  • Phone: 301-258-2765
  • Fax: 301-740-3577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberR084348
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: