Individual
MR. KEVIN MICHAEL JOHNSON SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
28 E SUSQUEHANNA AVE STE 101&102, TOWSON, MD 21286-5218
(443) 685-8565
Mailing address
28 E SUSQUEHANNA AVE STE 101&102, TOWSON, MD 21286-5218
(443) 685-8565
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NA
—
MD
Enumeration date
12/23/2020
Last updated
12/23/2020
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