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NPI Code Detail

MEDICARE: SAMANTHA JOHNSON BCBA, LBA

MEDICARE: SAMANTHA JOHNSON BCBA, LBA
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
1106S00000XBehavior Technician
2103K00000XBehavior Analyst0133003946VA

General Provider Information

NPI Number : 1689339194
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA JOHNSON BCBA, LBA
Provider Business Mailing Address
First Line : 130 CARRIEBROOKE DR
Second Line :
City : STEPHENS CITY
State : VA
Zip : 22655-6000
Country : US
Telephone Number : 540-486-4653
Fax Number :
Provider Business Practice Location Address
First Line : 130 CARRIEBROOKE DR
Second Line :
City : STEPHENS CITY
State : VA
Zip : 22655-6000
Country : US
Telephone Number : 540-486-4653
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2021
Last Update Date : 04/17/2025

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