MEDICARE: SHENIQUA LA'QUET JOHNSON LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	0904017518	VA
2	251B00000X	Case Management Agency
3	251S00000X	Community/Behavioral Health Agency
4	1041C0700X	Clinical Social Worker	0904017518	VA

General Provider Information

NPI Number	:	1053133728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHENIQUA LA'QUET JOHNSON LCSW

Provider Business Mailing Address
First Line	:	2807 HULL ST STE 200
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23224-3615
Country	:	US
Telephone Number	:	804-278-7921
Fax Number	:

Provider Business Practice Location Address
First Line	:	2807 HULL ST STE 200
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23224-3615
Country	:	US
Telephone Number	:	804-278-7921
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2024
Last Update Date	:	10/24/2024

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