1598500480 NPI number — MISS SOPHIA G YOUNG B.A., M.S.A., M.A.

Table of content: VON LEEBRINA JOHNSON (NPI 1942016167)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598500480 NPI number — MISS SOPHIA G YOUNG B.A., M.S.A., M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YOUNG
Provider First Name:
SOPHIA
Provider Middle Name:
G
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
B.A., M.S.A., M.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598500480
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15412 ROSEMONT MANOR DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAYMARKET
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20169-6240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-253-7798
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
46553 VALLEY CT APT 6005
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON PARK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20653-1851
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-253-7798
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/01/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: L25136649 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 310400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 376J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 374U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 171W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)