Healthcare Provider Details

I. General information

NPI: 1396839320
Provider Name (Legal Business Name): STEPHANIE JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8429 CHARMED DAYS
LAUREL MD
20723-5611
US

IV. Provider business mailing address

8429 CHARMED DAYS
LAUREL MD
20723-5611
US

V. Phone/Fax

Practice location:
  • Phone: 210-704-7179
  • Fax:
Mailing address:
  • Phone: 240-704-7179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPRC15060
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0701007868
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number18656
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701007868
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPRC15060
License Number StateDC
# 6
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number18656
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: