Healthcare Provider Details

I. General information

NPI: 1699695528
Provider Name (Legal Business Name): CHEYENNE DANIELLE JOHNSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 S 5TH ST
RICHMOND VA
23219-3825
US

IV. Provider business mailing address

824 W 46TH ST
RICHMOND VA
23225-4628
US

V. Phone/Fax

Practice location:
  • Phone: 804-637-1455
  • Fax:
Mailing address:
  • Phone: 757-706-0141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904020771
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: