Provider Demographics
NPI:1386158517
Name:JOHNSON-PUGH, SHONDELLE (CLINICAL SOCIAL WORK)
Entity type:Individual
Prefix:MRS
First Name:SHONDELLE
Middle Name:
Last Name:JOHNSON-PUGH
Suffix:
Gender:F
Credentials:CLINICAL SOCIAL WORK
Other - Prefix:MRS
Other - First Name:SHONDELLE
Other - Middle Name:
Other - Last Name:JOHNSON-PUGH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LCSWC
Mailing Address - Street 1:8898 ATHOL RD
Mailing Address - Street 2:
Mailing Address - City:MARDELA SPRINGS
Mailing Address - State:MD
Mailing Address - Zip Code:21837-2408
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:225 N DIVISION ST STE 204
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-4302
Practice Address - Country:US
Practice Address - Phone:443-978-7864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-27
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MD1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health