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General NPI Number Information
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NPI Number | 1770903379
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Entity Type | Organization
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Legal Business Name | JOE T. JOHNSON, LCSW LLC
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Dates
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Enumeration Date | 04/22/2014
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Last Update Date | 04/22/2014
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Provider Practice Location Address
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Address Line | 404 CHATHAM SQ PARK SQUARE OFFICE PARK
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City | FREDERICKSBURG
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State | VA
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Zip | 22405-2544
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Country | US
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Telephone | 540-373-1200
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Fax | 540-373-1283
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Provider Business Mailing Address
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Address Line | 10323 EDINBURGH DR
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City | SPOTSYLVANIA
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State | VA
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Zip | 22553-1733
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Country | US
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Telephone | 540-809-1589
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Fax | 540-741-3918
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | JOE THOMAS JOHNSON
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Credential | LCSW
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Telephone | 540-809-1589
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904003387
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License Number State | VA
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