MEDICARE: MS. KARA JOHNSON-SMITH LCMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	LCM196	MD

General Provider Information

NPI Number	:	1255440434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KARA JOHNSON-SMITH LCMFT

Provider Business Mailing Address
First Line	:	3510 WORTHINGTON BLVD STE 101
Second Line	:
City	:	URBANA
State	:	MD
Zip	:	21704-7033
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3510 WORTHINGTON BLVD STE 101
Second Line	:
City	:	URBANA
State	:	MD
Zip	:	21704
Country	:	US
Telephone Number	:	240-206-1509
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	05/30/2019

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