Individual
STEPHANIE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8429 CHARMED DAYS, LAUREL, MD 20723-5611
(210) 704-7179
Mailing address
8429 CHARMED DAYS, LAUREL, MD 20723-5611
(240) 704-7179
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
0701007868
VA
101Y00000X
Counselor
18656
TX
101Y00000X
Counselor
PRC15060
DC
101YP2500X
Professional Counselor
Primary
0701007868
VA
101YP2500X
Professional Counselor
18656
TX
101YP2500X
Professional Counselor
PRC15060
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
166332003
—
TX
Enumeration date
10/03/2006
Last updated
11/06/2024
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