=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902081599
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. VICTORIA Y JOHNSON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/02/2008
-----------------------------------------------------
Last Update Date | 08/28/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3243 BELLVILLE DR
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75228-5672
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-405-8523
-----------------------------------------------------
Fax | 214-660-9098
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3243 BELLVILLE DR
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75228-5672
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-405-8523
-----------------------------------------------------
Fax | 214-660-9098
-----------------------------------------------------
=====================================================
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 | NA06445762
-----------------------------------------------------
License Number State |
-----------------------------------------------------