Provider Demographics
NPI:1225538259
Name:JOHNSON, DEANA (PSYCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:DEANA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:STANLEYTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:24168-3001
Mailing Address - Country:US
Mailing Address - Phone:276-634-4700
Mailing Address - Fax:
Practice Address - Street 1:74 EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:STANLEYTOWN
Practice Address - State:VA
Practice Address - Zip Code:24168-3001
Practice Address - Country:US
Practice Address - Phone:276-634-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0813000176103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool