MEDICARE: SLJ PROFESSIONAL SERVICES LLC

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

General Provider Information

NPI Number	:	1760317770
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SLJ PROFESSIONAL SERVICES LLC

Provider Business Mailing Address
First Line	:	9273 1ST VIEW ST
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23503-4225
Country	:	US
Telephone Number	:	757-895-1837
Fax Number	:

Provider Business Practice Location Address
First Line	:	9273 1ST VIEW ST
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23503-4225
Country	:	US
Telephone Number	:	757-895-1837
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SIERRA JOHNSON
Credential	:	LPC
Telephone Number	:	757-895-1837

Provider Enumeration Date	:	06/13/2026
Last Update Date	:	06/13/2026

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