Provider Demographics
NPI:1235505363
Name:JOHNSON, MALKIA (LCSW-C)
Entity Type:Individual
Prefix:DR
First Name:MALKIA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 335
Mailing Address - Street 2:
Mailing Address - City:HURLOCK
Mailing Address - State:MD
Mailing Address - Zip Code:21643-0335
Mailing Address - Country:US
Mailing Address - Phone:410-829-4059
Mailing Address - Fax:
Practice Address - Street 1:5304 CEDAR DR
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-4404
Practice Address - Country:US
Practice Address - Phone:410-829-4059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD143391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD097684900Medicaid