Provider Demographics
NPI:1326237876
Name:JOHNSON, TONYIA DEE (MED, LCADC, LCPC)
Entity Type:Individual
Prefix:
First Name:TONYIA
Middle Name:DEE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MED, LCADC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15310 CHRISTY LN
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-4304
Mailing Address - Country:US
Mailing Address - Phone:301-645-4336
Mailing Address - Fax:
Practice Address - Street 1:3235 LEONARDTOWN RD
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-3614
Practice Address - Country:US
Practice Address - Phone:301-645-4336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA168101YA0400X, 101YA0400X
MDLC5980101YM0800X, 101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral