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General NPI Number Information
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NPI Number | 1154647485
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Entity Type | Individual
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Provider Name | TERRI EVETTE JOHNSON MSW, LCSW-C, LCADC
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Gender | Female
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Dates
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Enumeration Date | 04/12/2010
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Last Update Date | 04/06/2022
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Provider Practice Location Address
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Address Line | 9650 SANTIAGO RD
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City | COLUMBIA
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State | MD
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Zip | 21045-3957
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Country | US
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Telephone | 443-858-7588
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Fax | 888-563-3403
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Provider Business Mailing Address
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Address Line | 7371 HICKORY LOG CIR
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City | COLUMBIA
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State | MD
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Zip | 21045-5030
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Country | US
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Telephone | 443-858-7588
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Fax | 888-563-3403
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 10389
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License Number State | MD
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