Provider Demographics
NPI:1619119062
Name:JOHNSON, HEIDI MAREE (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:MAREE
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 1:6541 SPECKER AVE
Mailing Address - Street 2:
Mailing Address - City:FORT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913-4263
Mailing Address - Country:US
Mailing Address - Phone:719-526-7876
Mailing Address - Fax:
Practice Address - Street 1:3701 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-4208
Practice Address - Country:US
Practice Address - Phone:410-558-4900
Practice Address - Fax:410-732-7000
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD138261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical