Healthcare Provider Details

I. General information

NPI: 1992365985
Provider Name (Legal Business Name): ARRYKKA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2019
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 LEGATO RD STE 1100
FAIRFAX VA
22033-2893
US

IV. Provider business mailing address

4806 SAINT BARNABAS RD UNIT 1710
TEMPLE HILLS MD
20748-9998
US

V. Phone/Fax

Practice location:
  • Phone: 240-923-2944
  • Fax:
Mailing address:
  • Phone: 202-600-6509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB1306625
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: