Healthcare Provider Details

I. General information

NPI: 1306717012
Provider Name (Legal Business Name): REBECCA MARELEN JOHNSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 PARAGON PL STE 237
RICHMOND VA
23230-1651
US

IV. Provider business mailing address

6800 PARAGON PL STE 237
RICHMOND VA
23230-1651
US

V. Phone/Fax

Practice location:
  • Phone: 804-562-9997
  • Fax: 804-918-8284
Mailing address:
  • Phone: 804-562-9997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701015376
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: