Provider Demographics
NPI:1386278489
Name:JOHNSON, DANELLE (LCSW-C)
Entity type:Individual
Prefix:
First Name:DANELLE
Middle Name:
Last Name:JOHNSON
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 1:6811 BELLONA AVE APT A
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-1223
Mailing Address - Country:US
Mailing Address - Phone:267-978-4788
Mailing Address - Fax:
Practice Address - Street 1:529 EDMUND ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-3429
Practice Address - Country:US
Practice Address - Phone:410-272-3278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD168211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical