Healthcare Provider Details

I. General information

NPI: 1770455271
Provider Name (Legal Business Name): MELISSA JOHNSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2025
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8310 MIDLOTHIAN TPKE
NORTH CHESTERFIELD VA
23235-5163
US

IV. Provider business mailing address

8310 MIDLOTHIAN TPKE
NORTH CHESTERFIELD VA
23235-5163
US

V. Phone/Fax

Practice location:
  • Phone: 804-447-6382
  • Fax: 804-447-6383
Mailing address:
  • Phone: 804-447-6382
  • Fax: 804-447-6383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904004831
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: