Provider Demographics
NPI:1689114357
Name:JOHNSON, DEANDRE PIERRE
Entity Type:Individual
Prefix:MR
First Name:DEANDRE
Middle Name:PIERRE
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:DEANDRE
Other - Middle Name:PIERRE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:4320 WOODLEA AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-5631
Mailing Address - Country:US
Mailing Address - Phone:443-374-8052
Mailing Address - Fax:
Practice Address - Street 1:4320 WOODLEA AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21206-5631
Practice Address - Country:US
Practice Address - Phone:443-374-8052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician