Healthcare Provider Details

I. General information

NPI: 1366350027
Provider Name (Legal Business Name): MICHELE LEIGH JOHNSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 INDIGO DAM RD
WILLIAMSBURG VA
23188-2591
US

IV. Provider business mailing address

153 INDIGO DAM RD
WILLIAMSBURG VA
23188-2591
US

V. Phone/Fax

Practice location:
  • Phone: 757-995-8397
  • Fax: 757-885-5144
Mailing address:
  • Phone: 757-995-8397
  • Fax: 757-885-5144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0904017144
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: