Healthcare Provider Details

I. General information

NPI: 1871223586
Provider Name (Legal Business Name): MICHELLE ST JOHN MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2022
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N GLEBE RD STE 1600
ARLINGTON VA
22201-5798
US

IV. Provider business mailing address

3040 WILLIAMS DR STE 100
FAIRFAX VA
22031-4618
US

V. Phone/Fax

Practice location:
  • Phone: 571-350-8400
  • Fax: 703-528-0338
Mailing address:
  • Phone: 571-350-8400
  • Fax: 703-940-8697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number0140000036
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: