Healthcare Provider Details

I. General information

NPI: 1679795637
Provider Name (Legal Business Name): VIRGINIA JOHNSON PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 01/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 E INTERCITY AVE STE A
EVERETT WA
98208-2732
US

IV. Provider business mailing address

127 E INTERCITY AVE STE A
EVERETT WA
98208-2732
US

V. Phone/Fax

Practice location:
  • Phone: 425-347-7275
  • Fax: 425-355-0626
Mailing address:
  • Phone: 425-347-7275
  • Fax: 425-355-0626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2927
License Number StateWA

VIII. Authorized Official

Name: VIRGINIA ANN JOHNSON
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 425-347-7275