Provider Demographics
NPI:1215557780
Name:JOHNSON, BREYONA LAKIA
Entity Type:Individual
Prefix:
First Name:BREYONA
Middle Name:LAKIA
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 1:1822 N BENTALOU ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21216-3729
Mailing Address - Country:US
Mailing Address - Phone:443-854-0716
Mailing Address - Fax:
Practice Address - Street 1:1822 N BENTALOU ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216-3729
Practice Address - Country:US
Practice Address - Phone:443-854-0716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician