Provider Demographics
NPI:1972950350
Name:JOHNSON, MONIFA N (LCSW-C, LICSW, LCSW)
Entity Type:Individual
Prefix:
First Name:MONIFA
Middle Name:N
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW-C, LICSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11942 TWINLAKES DR
Mailing Address - Street 2:33
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-3183
Mailing Address - Country:US
Mailing Address - Phone:240-716-0552
Mailing Address - Fax:
Practice Address - Street 1:3341 BENNING RD NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-1502
Practice Address - Country:US
Practice Address - Phone:202-543-0387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500806521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical