Provider Demographics
NPI:1114562113
Name:JOHNSON, ANGELA M (LPC)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7870 TIDEWATER DR STE 206
Mailing Address - Street 2:180
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-3713
Mailing Address - Country:US
Mailing Address - Phone:757-748-8058
Mailing Address - Fax:
Practice Address - Street 1:7464 TIDEWATER DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-3845
Practice Address - Country:US
Practice Address - Phone:757-664-6679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-13
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008690101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional