=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073643763
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | XANTHIA BIANCA JOHNSON M.A.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2007
-----------------------------------------------------
Last Update Date | 10/24/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 601 PENNSYLVANIA AVE NW SUITE 900 SOUTH BUILDING
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20004-2601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-565-5422
-----------------------------------------------------
Fax | 202-639-8238
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3913 PENNSYLVANIA AVE SE
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20020-1101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-565-5422
-----------------------------------------------------
Fax | 202-518-8924
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | PRC13968
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------