Provider Demographics
NPI:1871062315
Name:JOHNSON, CANDACE AMANDA (LCSW-C)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:AMANDA
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 1:1301 CONTINENTAL DR STE 101
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-2338
Mailing Address - Country:US
Mailing Address - Phone:667-600-3217
Mailing Address - Fax:
Practice Address - Street 1:1301 CONTINENTAL DR STE 101
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009-2338
Practice Address - Country:US
Practice Address - Phone:667-600-3217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD193791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical