Individual
KENNETH MAURICE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3911 OLD LEE HWY STE 43B, FAIRFAX, VA 22030-2434
(301) 523-7843
Mailing address
3911 OLD LEE HWY STE 43B, FAIRFAX, VA 22030-2434
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904013452
VA
Other
Enumeration date
12/13/2022
Last updated
12/13/2022
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