Provider Demographics
NPI:1093376774
Name:SMITH-JOHNSON, CHARLINE (RBT)
Entity Type:Individual
Prefix:
First Name:CHARLINE
Middle Name:
Last Name:SMITH-JOHNSON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1356 ADAMS ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-3545
Mailing Address - Country:US
Mailing Address - Phone:202-489-8642
Mailing Address - Fax:
Practice Address - Street 1:1356 ADAMS ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-3545
Practice Address - Country:US
Practice Address - Phone:202-489-8642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-24
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRBT-13-01720103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCRBT-13-01720Medicaid