Healthcare Provider Details

I. General information

NPI: 1861966582
Provider Name (Legal Business Name): ERICA E JOHNSON LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2019
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4216 SILVER SPRING RD
PERRY HALL MD
21128-9659
US

IV. Provider business mailing address

4004 TIDEWOOD RD
BALTIMORE MD
21220-2376
US

V. Phone/Fax

Practice location:
  • Phone: 410-893-4600
  • Fax: 443-640-4358
Mailing address:
  • Phone: 410-893-4600
  • Fax: 443-640-4358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number23998
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number23998
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: