Healthcare Provider Details

I. General information

NPI: 1548900954
Provider Name (Legal Business Name): URSULA LIEBOWITZ-JOHNSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2022
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2604 N PARHAM RD
RICHMOND VA
23294-4649
US

IV. Provider business mailing address

PO BOX 2549
GLEN ALLEN VA
23058-2549
US

V. Phone/Fax

Practice location:
  • Phone: 804-651-2525
  • Fax: 804-230-0998
Mailing address:
  • Phone: 804-681-2525
  • Fax: 804-230-0998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904013545
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: