Provider Demographics
NPI:1306979901
Name:JOHANNISSON, LINDA LORAINE (LCSW-C)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:LORAINE
Last Name:JOHANNISSON
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2964 PYSELL CROSSCUT RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21550-4825
Mailing Address - Country:US
Mailing Address - Phone:240-321-6136
Mailing Address - Fax:410-778-0836
Practice Address - Street 1:2964 PYSELL CROSSCUT RD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-4825
Practice Address - Country:US
Practice Address - Phone:240-321-6136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD092661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD62-96218OtherUBH
MD641712-01OtherBCBS LOCAL
MD100081540001OtherAPS
MD121748OtherJOHNS HOPKINS
MD2128571OtherMAMSI
MDT4180013OtherBCBS NATIONAL
MD641712-01OtherBCBS LOCAL