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NPI Code Detail

MEDICARE: KATHY L JOHNSON QMHP A QMHP C

MEDICARE: KATHY L JOHNSON QMHP A QMHP C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor0732004768VA
2171M00000XCase Manager/Care Coordinator
3172V00000XCommunity Health Worker
4101YA0400XAddiction (Substance Use Disorder) Counselor0709025903VA

General Provider Information

NPI Number : 1053785758
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHY L JOHNSON QMHP A QMHP C
Provider Business Mailing Address
First Line : 1535 MT VERNON AVE
Second Line :
City : PORTSMOUTH
State : VA
Zip : 23707-3511
Country : US
Telephone Number : 757-409-2851
Fax Number :
Provider Business Practice Location Address
First Line : 4009 SCHOONER TRL
Second Line :
City : CHESAPEAKE
State : VA
Zip : 23321-3217
Country : US
Telephone Number : 757-409-2851
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/18/2015
Last Update Date : 01/06/2026

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