Healthcare Provider Details

I. General information

NPI: 1073643763
Provider Name (Legal Business Name): XANTHIA BIANCA JOHNSON M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 10/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 PENNSYLVANIA AVE NW SUITE 900 SOUTH BUILDING
WASHINGTON DC
20004-2601
US

IV. Provider business mailing address

3913 PENNSYLVANIA AVE SE
WASHINGTON DC
20020-1101
US

V. Phone/Fax

Practice location:
  • Phone: 240-565-5422
  • Fax: 202-639-8238
Mailing address:
  • Phone: 240-565-5422
  • Fax: 202-518-8924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPRC13968
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: