Provider Demographics
NPI:1407579261
Name:JOHNSON, COLLEEN FOWKES (BCBA)
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:FOWKES
Last Name:JOHNSON
Suffix:
Gender:
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7090 SAMUEL MORSE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-3444
Mailing Address - Country:US
Mailing Address - Phone:571-262-9979
Mailing Address - Fax:
Practice Address - Street 1:7090 SAMUEL MORSE DR STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-3444
Practice Address - Country:US
Practice Address - Phone:855-935-3691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst