MEDICARE: DR. LINDA JOHNSON PH.D.

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	103TC0700X	Clinical Psychologist	0810002580	VA

General Provider Information

NPI Number	:	1982820312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINDA JOHNSON PH.D.

Provider Business Mailing Address
First Line	:	2560 HUNTINGTON AVE STE 302
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22303-1448
Country	:	US
Telephone Number	:	703-765-6115
Fax Number	:	703-765-6115

Provider Business Practice Location Address
First Line	:	2560 HUNTINGTON AVE STE 302
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22303-1448
Country	:	US
Telephone Number	:	703-765-6115
Fax Number	:	703-765-6115

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

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	02/03/2021

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