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General NPI Number Information
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NPI Number | 1114562113
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Entity Type | Individual
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Provider Name | ANGELA M JOHNSON LPC
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Gender | Female
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Dates
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Enumeration Date | 11/13/2019
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Last Update Date | 02/14/2020
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Provider Practice Location Address
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Address Line | 7464 TIDEWATER DR
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City | NORFOLK
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State | VA
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Zip | 23505-3845
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Country | US
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Telephone | 757-664-6679
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Fax |
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Provider Business Mailing Address
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Address Line | 7870 TIDEWATER DR STE 206 180
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City | NORFOLK
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State | VA
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Zip | 23505-3713
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Country | US
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Telephone | 757-748-8058
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701008690
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License Number State | VA
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