Individual
ANDREA MICHELLE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
9403 POCOHANTAS TRAIL, PROVIDENCE FORGE, VA 23140
(804) 966-5959
(804) 966-5694
Mailing address
10299 WOODMAN RD, GLEN ALLEN, VA 23060-4419
(804) 727-8500
(804) 727-8580
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904003117
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110331
ANTHEM
VA
01
—
2169315
MAMSI
VA
01
—
272779-000
MAGELLAN
VA
01
—
O84784
OPTIMA
VA
Enumeration date
02/12/2007
Last updated
09/26/2008
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