Individual
IDA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1114 BENFIELD BLVD STE G, MILLERSVILLE, MD 21108-2589
(410) 780-5203
Mailing address
1114 BENFIELD BLVD STE G, MILLERSVILLE, MD 21108-2589
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
17031
MD
Other
Enumeration date
09/29/2016
Last updated
09/29/2016
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