Provider Demographics
NPI:1508303686
Name:JOHNSON, DEANA (LCSW-C)
Entity Type:Individual
Prefix:
First Name:DEANA
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 1:320 E TOWSONTOWN BLVD
Mailing Address - Street 2:SUITE 2W
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-5318
Mailing Address - Country:US
Mailing Address - Phone:410-296-2004
Mailing Address - Fax:
Practice Address - Street 1:120 SISTER PIERRE DR STE 506
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-7527
Practice Address - Country:US
Practice Address - Phone:410-670-4769
Practice Address - Fax:410-847-2545
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-26
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD152221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD05Medicaid