Healthcare Provider Details

I. General information

NPI: 1801394382
Provider Name (Legal Business Name): TONYA DORLINE JOHNSON LCSW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2018
Last Update Date: 01/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 THIMBLE SHOALS BLVD STE 404
NEWPORT NEWS VA
23606-4509
US

IV. Provider business mailing address

610 THIMBLE SHOALS BLVD STE 403
NEWPORT NEWS VA
23606-2573
US

V. Phone/Fax

Practice location:
  • Phone: 757-291-3339
  • Fax:
Mailing address:
  • Phone: 757-534-7840
  • Fax: 757-534-7844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. TONYA DORLINE JOHNSON
Title or Position: CEO
Credential: LCSW
Phone: 757-291-3339