Healthcare Provider Details

I. General information

NPI: 1487041588
Provider Name (Legal Business Name): JOANNE M JOHNSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2015
Last Update Date: 09/10/2022
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16712 JEFFERSON DAVIS HWY
DUMFRIES VA
22026-2115
US

IV. Provider business mailing address

187 WOODSTREAM BLVD # A
STAFFORD VA
22556-4629
US

V. Phone/Fax

Practice location:
  • Phone: 855-417-2486
  • Fax: 703-221-4115
Mailing address:
  • Phone: 540-729-4104
  • Fax: 703-204-9001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701005960
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: