Provider Demographics
NPI:1053465211
Name:WAYNE, JOHANNA S (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:JOHANNA
Middle Name:S
Last Name:WAYNE
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 S MAIN ST STE 2CA
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-3978
Mailing Address - Country:US
Mailing Address - Phone:410-688-1058
Mailing Address - Fax:
Practice Address - Street 1:336 S MAIN ST STE 2CA
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3978
Practice Address - Country:US
Practice Address - Phone:410-688-1058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD130951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical