MEDICARE: JOANNE M JOHNSON LPC

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	101YP2500X	Professional Counselor	0701005960	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0001210981	OTHER	TX	RN LICENSE

General Provider Information

NPI Number	:	1487041588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNE M JOHNSON LPC

Provider Business Mailing Address
First Line	:	187 WOODSTREAM BLVD # A
Second Line	:
City	:	STAFFORD
State	:	VA
Zip	:	22556-4629
Country	:	US
Telephone Number	:	540-729-4104
Fax Number	:	703-204-9001

Provider Business Practice Location Address
First Line	:	16712 JEFFERSON DAVIS HWY
Second Line	:
City	:	DUMFRIES
State	:	VA
Zip	:	22026-2115
Country	:	US
Telephone Number	:	855-417-2486
Fax Number	:	703-221-4115

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

Provider Enumeration Date	:	04/16/2015
Last Update Date	:	09/10/2022

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