Healthcare Provider Details

I. General information

NPI: 1952826034
Provider Name (Legal Business Name): DEBORAH JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 WASHINGTON BLVD FL 3
ARLINGTON VA
22204-5718
US

IV. Provider business mailing address

2120 WASHINGTON BLVD FL 3
ARLINGTON VA
22204-5718
US

V. Phone/Fax

Practice location:
  • Phone: 703-228-5150
  • Fax: 703-228-5157
Mailing address:
  • Phone: 703-228-5150
  • Fax: 703-228-5157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701006552
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: