Provider Demographics
NPI:1518937440
Name:WILLIAMS-JOHNSON, TINA M (CSC-AD)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:WILLIAMS-JOHNSON
Suffix:
Gender:F
Credentials:CSC-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 W SARATOGA ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21223-1749
Mailing Address - Country:US
Mailing Address - Phone:410-383-3109
Mailing Address - Fax:410-383-3131
Practice Address - Street 1:1501 W SARATOGA ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21223-1749
Practice Address - Country:US
Practice Address - Phone:410-383-3109
Practice Address - Fax:410-383-3131
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDSC1302101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor