Provider Demographics
NPI:1891191052
Name:JOHNSON, ANJALISSA D (LCADC, SAP, MAC)
Entity type:Individual
Prefix:
First Name:ANJALISSA
Middle Name:D
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCADC, SAP, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10400 CRANBROOK HILLS PL APT J
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-2717
Mailing Address - Country:US
Mailing Address - Phone:443-983-5001
Mailing Address - Fax:
Practice Address - Street 1:10400 CRANBROOK HILLS PL APT J
Practice Address - Street 2:
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-2717
Practice Address - Country:US
Practice Address - Phone:443-380-0534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-14
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA3226101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)