Healthcare Provider Details

I. General information

NPI: 1790596286
Provider Name (Legal Business Name): SHAQUIVIA JOHNSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2025
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6160 KEMPSVILLE CIR STE 325A
NORFOLK VA
23502-3933
US

IV. Provider business mailing address

1509 HACKENSACK RD
VIRGINIA BEACH VA
23455-3415
US

V. Phone/Fax

Practice location:
  • Phone: 757-354-2885
  • Fax: 757-917-5141
Mailing address:
  • Phone: 757-438-5872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number0904017749
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: