Provider Demographics
NPI:1548727308
Name:JOHNSON, AYANA (LCPC, MA)
Entity type:Individual
Prefix:
First Name:AYANA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCPC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 POMONA W APT 5
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-3441
Mailing Address - Country:US
Mailing Address - Phone:443-852-4799
Mailing Address - Fax:
Practice Address - Street 1:3319 W BELVEDERE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5143
Practice Address - Country:US
Practice Address - Phone:443-884-7648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-27
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP8016101YM0800X
MDLC11377101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health