MEDICARE: MS. AMANDA ELLEN JOHNSON

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
1	101YM0800X	Mental Health Counselor	0704018879	VA

General Provider Information

NPI Number	:	1346199825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMANDA ELLEN JOHNSON

Provider Business Mailing Address
First Line	:	44135 WOODRIDGE PKWY
Second Line	:
City	:	LEESBURG
State	:	VA
Zip	:	20176-8282
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	44135 WOODRIDGE PKWY
Second Line	:
City	:	LEESBURG
State	:	VA
Zip	:	20176-8282
Country	:	US
Telephone Number	:	703-520-2437
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2026
Last Update Date	:	01/27/2026

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