Healthcare Provider Details

I. General information

NPI: 1053785758
Provider Name (Legal Business Name): KATHY L JOHNSON QMHP A QMHP C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2015
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4009 SCHOONER TRL
CHESAPEAKE VA
23321-3217
US

IV. Provider business mailing address

1535 MT VERNON AVE
PORTSMOUTH VA
23707-3511
US

V. Phone/Fax

Practice location:
  • Phone: 757-409-2851
  • Fax:
Mailing address:
  • Phone: 757-409-2851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0732004768
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0709025903
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: