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General NPI Number Information
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NPI Number | 1598236226
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Entity Type | Individual
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Provider Name | MARY ELIZABETH SEREY JOHNSON LC-PC
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Gender | Female
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Dates
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Enumeration Date | 12/06/2018
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Last Update Date | 12/06/2018
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Provider Practice Location Address
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Address Line | 81 W FREDERICK ST
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City | WALKERSVILLE
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State | MD
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Zip | 21793-8216
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Country | US
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Telephone | 240-236-7200
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Fax |
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Provider Business Mailing Address
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Address Line | 191 S EAST ST
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City | FREDERICK
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State | MD
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Zip | 21701-5918
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Country | US
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Telephone | 240-236-7200
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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 | LC2304
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License Number State | MD
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