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General NPI Number Information
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NPI Number | 1477046324
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Entity Type | Individual
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Provider Name | TONIA JEANNE JOHNSON CSAC
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Gender | Female
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Dates
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Enumeration Date | 06/14/2018
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Last Update Date | 06/14/2018
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Provider Practice Location Address
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Address Line | 111 TOWN HOLLOW RD
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City | CEDAR BLUFF
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State | VA
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Zip | 24609-9622
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Country | US
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Telephone | 276-963-3554
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Fax |
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Provider Business Mailing Address
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Address Line | 1077 CRACKERS NECK RD
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City | CLEVELAND
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State | VA
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Zip | 24225-7081
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Country | US
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Telephone | 276-254-0837
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0710102843
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License Number State | VA
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