Provider Demographics
NPI:1689451346
Name:BANKS JOHNSON, KARMALA (LCSW-C)
Entity Type:Individual
Prefix:
First Name:KARMALA
Middle Name:
Last Name:BANKS JOHNSON
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:KARMALA
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:30 SCARLETT DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20639-3711
Mailing Address - Country:US
Mailing Address - Phone:301-806-1638
Mailing Address - Fax:
Practice Address - Street 1:12200 SOUTHERN CONNECTOR BLVD
Practice Address - Street 2:
Practice Address - City:LUSBY
Practice Address - State:MD
Practice Address - Zip Code:20657-2760
Practice Address - Country:US
Practice Address - Phone:443-550-9215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD292311041S0200X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool