Provider Demographics
NPI:1154793404
Name:TOOMER, JONISHA
Entity type:Individual
Prefix:
First Name:JONISHA
Middle Name:
Last Name:TOOMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 E NORTHERN PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-2113
Mailing Address - Country:US
Mailing Address - Phone:443-961-7063
Mailing Address - Fax:
Practice Address - Street 1:1900 E NORTHERN PKWY STE 110
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-2113
Practice Address - Country:US
Practice Address - Phone:443-961-7063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-27
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC6334101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional