1770903379 NPI number — JOE T. JOHNSON, LCSW LLC

Table of content: (NPI 1770903379)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770903379 NPI number — JOE T. JOHNSON, LCSW LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOE T. JOHNSON, LCSW LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1770903379
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10323 EDINBURGH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPOTSYLVANIA
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22553-1733
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-809-1589
Provider Business Mailing Address Fax Number:
540-741-3918

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
404 CHATHAM SQ PARK
Provider Second Line Business Practice Location Address:
SQUARE OFFICE PARK
Provider Business Practice Location Address City Name:
FREDERICKSBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22405-2544
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-373-1200
Provider Business Practice Location Address Fax Number:
540-373-1283
Provider Enumeration Date:
04/22/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
JOE
Authorized Official Middle Name:
THOMAS
Authorized Official Title or Position:
SOLE PROPRIETOR
Authorized Official Telephone Number:
540-809-1589

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  0904003387 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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