Healthcare Provider Details

I. General information

NPI: 1982560850
Provider Name (Legal Business Name): EUNMEE SONG JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43883 STRONGHOLD CT
ASHBURN VA
20147-3919
US

IV. Provider business mailing address

43883 STRONGHOLD CT
ASHBURN VA
20147-3919
US

V. Phone/Fax

Practice location:
  • Phone: 703-401-1360
  • Fax:
Mailing address:
  • Phone: 703-401-1360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701015465
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: