Healthcare Provider Details

I. General information

NPI: 1891191052
Provider Name (Legal Business Name): ANJALISSA D JOHNSON LCADC, SAP, MAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2014
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 RAINFLOWER PATH UNIT 201
SPARKS GLENCOE MD
21152-8792
US

IV. Provider business mailing address

14 RAINFLOWER PATH UNIT 201
SPARKS GLENCOE MD
21152-8792
US

V. Phone/Fax

Practice location:
  • Phone: 443-983-5001
  • Fax:
Mailing address:
  • Phone: 443-983-5001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCA3226
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: