Individual
JACOB JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LGPC
Contact information
Practice address
7658 BELAIR RD, NOTTINGHAM, MD 21236-4020
(410) 800-2169
Mailing address
127 N MILTON AVE, BALTIMORE, MD 21224-1049
(941) 323-0573
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LGP15741
MD
Other
Enumeration date
10/29/2024
Last updated
11/11/2024
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