Provider Demographics
NPI:1538173588
Name:JOHNSON, ASIA MARIA (MA, LCPC)
Entity type:Individual
Prefix:MISS
First Name:ASIA
Middle Name:MARIA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:ASIA
Other - Middle Name:MARIA
Other - Last Name:AL-MATEEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LCPC
Mailing Address - Street 1:2001 FITZWARREN PL.
Mailing Address - Street 2:TI
Mailing Address - City:BALTO
Mailing Address - State:MD
Mailing Address - Zip Code:21209
Mailing Address - Country:US
Mailing Address - Phone:410-982-1353
Mailing Address - Fax:301-868-2032
Practice Address - Street 1:3238 BELAIR RD.
Practice Address - Street 2:1
Practice Address - City:BALTO.
Practice Address - State:MD
Practice Address - Zip Code:21213
Practice Address - Country:US
Practice Address - Phone:443-405-1095
Practice Address - Fax:443-766-1713
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2133101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD410126000Medicaid