Healthcare Provider Details

I. General information

NPI: 1891602959
Provider Name (Legal Business Name): ANNE PHANUELLE CHARLES JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 BLACK ROCK RD STE 103
HAMPSTEAD MD
21074-2649
US

IV. Provider business mailing address

4500 BLACK ROCK RD STE 103
HAMPSTEAD MD
21074-2649
US

V. Phone/Fax

Practice location:
  • Phone: 443-690-8041
  • Fax:
Mailing address:
  • Phone: 443-690-8041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number35284
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: