Healthcare Provider Details

I. General information

NPI: 1821282807
Provider Name (Legal Business Name): JOHARI MAKEBA MASSEY M.A., M.S., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 RUSSELL AVE
GWYNN OAK MD
21207-5219
US

IV. Provider business mailing address

2513 N ROLLING RD UNIT 47071
WINDSOR MILL MD
21244-7603
US

V. Phone/Fax

Practice location:
  • Phone: 646-246-9655
  • Fax: 410-944-6290
Mailing address:
  • Phone: 443-272-5347
  • Fax: 410-944-6290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number05339
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number019895
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number05339
License Number StateMD
# 5
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number05339
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: