Provider Demographics
NPI:1205407913
Name:JOHNSON, JASMYNE EVELYN GARLAND
Entity Type:Individual
Prefix:
First Name:JASMYNE
Middle Name:EVELYN GARLAND
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 1:12222 QUADRILLE LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-4386
Mailing Address - Country:US
Mailing Address - Phone:240-593-2209
Mailing Address - Fax:
Practice Address - Street 1:7225 HANOVER PKWY STE C
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2024
Practice Address - Country:US
Practice Address - Phone:240-459-3074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-03
Last Update Date:2021-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP9398101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health