Provider Demographics
NPI:1710578562
Name:JOHNSON, TERESIA JONAY (LMSW)
Entity Type:Individual
Prefix:
First Name:TERESIA
Middle Name:JONAY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8125 EVENING STAR DR UNIT 441
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-2484
Mailing Address - Country:US
Mailing Address - Phone:240-478-9692
Mailing Address - Fax:
Practice Address - Street 1:8125 EVENING STAR DR UNIT 441
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-2484
Practice Address - Country:US
Practice Address - Phone:240-478-9692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26699104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker