Provider Demographics
NPI:1407677719
Name:JOHNSON, KRISTINA (LMSW, QMHP-A)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMSW, QMHP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6655 SANTA BARBARA RD UNIT 8574
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-7523
Mailing Address - Country:US
Mailing Address - Phone:866-968-6342
Mailing Address - Fax:
Practice Address - Street 1:6655 SANTA BARBARA RD UNIT 8574
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-7523
Practice Address - Country:US
Practice Address - Phone:866-968-6342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-19
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0903004356104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker