Provider Demographics
NPI:1619309408
Name:JOHNSON, NORA (CAC-AD)
Entity Type:Individual
Prefix:MS
First Name:NORA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CAC-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3712 WOODHAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21216-1519
Mailing Address - Country:US
Mailing Address - Phone:410-961-5640
Mailing Address - Fax:
Practice Address - Street 1:3712 WOODHAVEN AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216-1519
Practice Address - Country:US
Practice Address - Phone:410-961-5640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC0228101YA0400X
MD035101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)