Individual
MARCUS TYRONE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6226 HEATHER GLEN DR, SUFFOLK, VA 23435-3133
(757) 374-1741
Mailing address
6226 HEATHER GLEN DR, SUFFOLK, VA 23435-3133
(757) 374-1741
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
7924
VA
Other
Enumeration date
10/23/2023
Last updated
10/23/2023
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