Healthcare Provider Details

I. General information

NPI: 1104720051
Provider Name (Legal Business Name): NOAH JOHNSTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 ENTERPRISE PKWY FL 2
RICHMOND VA
23294-6341
US

IV. Provider business mailing address

2727 ENTERPRISE PKWY FL 2
RICHMOND VA
23294-6341
US

V. Phone/Fax

Practice location:
  • Phone: 804-372-0151
  • Fax: 804-912-2163
Mailing address:
  • Phone: 804-372-0151
  • Fax: 804-912-2163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0134000693
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: