Provider Demographics
NPI:1154073922
Name:JOHNSON, CHRISTINE LYNETTE
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:LYNETTE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21205-1832
Mailing Address - Country:US
Mailing Address - Phone:443-923-9200
Mailing Address - Fax:
Practice Address - Street 1:1741 ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21205-1531
Practice Address - Country:US
Practice Address - Phone:443-923-1870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical