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NPI Code Detail

MEDICARE: SCARLETE JOHNSON

MEDICARE: SCARLETE 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
1101YA0400XAddiction (Substance Use Disorder) Counselor0710103790VA
2101YP2500XProfessional Counselor0701012561VA

General Provider Information

NPI Number : 1871287011
Entity Type Code : Individual
Provider Name (Legal Business Name) : SCARLETE JOHNSON
Provider Business Mailing Address
First Line : 12298 DAPPLE GRAY CT
Second Line :
City : WOODBRIDGE
State : VA
Zip : 22192-6215
Country : US
Telephone Number : 571-364-1901
Fax Number :
Provider Business Practice Location Address
First Line : 14000 CROWN CT STE 101
Second Line :
City : WOODBRIDGE
State : VA
Zip : 22193-1461
Country : US
Telephone Number : 703-659-9903
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2023
Last Update Date : 06/08/2023

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