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General NPI Number Information
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NPI Number | 1255087821
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Entity Type | Individual
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Provider Name | TANYA Y. JOHNSON LCPC
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Gender | Female
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Dates
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Enumeration Date | 02/23/2022
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Last Update Date | 02/23/2022
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Provider Practice Location Address
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Address Line | 583 FREDERICK RD STE 6C
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City | CATONSVILLE
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State | MD
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Zip | 21228-4697
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Country | US
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Telephone | 443-341-6332
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Fax |
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Provider Business Mailing Address
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Address Line | 5114 BIRCHMERE TER
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City | BOWIE
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State | MD
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Zip | 20720-4883
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Country | US
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Telephone | 240-888-5546
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Fax |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LC12266
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License Number State | MD
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