=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669392221
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TAMARA M JOHNSON LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/15/2026
-----------------------------------------------------
Last Update Date | 07/15/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8479 SAINT ANTHONYS RD
-----------------------------------------------------
City | KING GEORGE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22485-3408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-775-9879
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8724 STEVENSON LN
-----------------------------------------------------
City | SPOTSYLVANIA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22553-1992
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-775-9879
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | 0701016386
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------