Provider Demographics
NPI:1477342319
Name:JOHNSON, MIKAYLA (LMSW)
Entity type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9653 LYNCHBURG PL
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-3876
Mailing Address - Country:US
Mailing Address - Phone:301-906-6216
Mailing Address - Fax:301-906-6216
Practice Address - Street 1:6100 RADIO STATION RD
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-3314
Practice Address - Country:US
Practice Address - Phone:301-906-6216
Practice Address - Fax:301-906-6216
Is Sole Proprietor?:No
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD32589104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker