Provider Demographics
NPI:1073643763
Name:JOHNSON, XANTHIA BIANCA (MA)
Entity Type:Individual
Prefix:MS
First Name:XANTHIA
Middle Name:BIANCA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3913 PENNSYLVANIA AVE SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-1101
Mailing Address - Country:US
Mailing Address - Phone:240-565-5422
Mailing Address - Fax:202-518-8924
Practice Address - Street 1:601 PENNSYLVANIA AVE NW
Practice Address - Street 2:SUITE 900 SOUTH BUILDING
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20004-2601
Practice Address - Country:US
Practice Address - Phone:240-565-5422
Practice Address - Fax:202-639-8238
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC13968101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health