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NPI Code Detail

MEDICARE: MICHELE B. JOHNSON LCSW

MEDICARE: MICHELE B. 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
11041C0700XClinical Social Worker0904009080VA

General Provider Information

NPI Number : 1710354451
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELE B. JOHNSON LCSW
Provider Business Mailing Address
First Line : PO BOX 1184
Second Line :
City : DUNNSVILLE
State : VA
Zip : 22454-1184
Country : US
Telephone Number : 804-761-0838
Fax Number : 804-695-8173
Provider Business Practice Location Address
First Line : 9950 COURTHOUSE RD
Second Line :
City : CHARLES CITY
State : VA
Zip : 23030-3434
Country : US
Telephone Number : 804-829-6600
Fax Number : 804-829-6182
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2015
Last Update Date : 08/06/2019

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Directions to “ MICHELE B. JOHNSON LCSW” Practice Location

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