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General NPI Number Information
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NPI Number | 1821302720
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Entity Type | Individual
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Provider Name | FAYTHE JOHNSON LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 08/03/2010
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Last Update Date | 06/13/2024
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Provider Practice Location Address
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Address Line | 14 S BROADWAY
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City | BALTIMORE
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State | MD
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Zip | 21231-1712
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Country | US
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Telephone | 410-276-1773
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Fax | 410-276-2056
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Provider Business Mailing Address
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Address Line | 1118 QUINCE APPLE PL
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City | DAVIDSONVILLE
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State | MD
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Zip | 21035-1231
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Country | US
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Telephone | 443-974-3027
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 16118
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License Number State | MD
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