Provider Demographics
NPI:1679310221
Name:JOHNSON, SHIMERE LENORA (RBT)
Entity type:Individual
Prefix:MS
First Name:SHIMERE
Middle Name:LENORA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 WALDEN HOLLY CT
Mailing Address - Street 2:
Mailing Address - City:GWYNN OAK
Mailing Address - State:MD
Mailing Address - Zip Code:21207-3941
Mailing Address - Country:US
Mailing Address - Phone:443-985-4697
Mailing Address - Fax:
Practice Address - Street 1:7600 OSLER DR STE 213
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7701
Practice Address - Country:US
Practice Address - Phone:888-547-2250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDBACB1095228106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician