Provider Demographics
NPI:1154647485
Name:JOHNSON, TERRI EVETTE (MSW, LCSW-C, LCADC)
Entity Type:Individual
Prefix:MS
First Name:TERRI
Middle Name:EVETTE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSW, LCSW-C, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7371 HICKORY LOG CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-5030
Mailing Address - Country:US
Mailing Address - Phone:443-858-7588
Mailing Address - Fax:888-563-3403
Practice Address - Street 1:9650 SANTIAGO RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-3957
Practice Address - Country:US
Practice Address - Phone:443-858-7588
Practice Address - Fax:888-563-3403
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10389104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker