Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | LCA168 | MD |
N | 101YM0800X | Mental Health Counselor | LC5980 | MD |
N | 101YP1600X | Pastoral Counselor | LC5980 | MD |
NPI | 1326237876 |
---|---|
Provider Name | Tonyia Dee Johnson |
First Address | Waldorf, MD 20601-4304 |
Second Address | Waldorf, MD 20601-3614 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2007 |
Last Update Date | 24/08/2015 |