Provider Demographics
NPI:1225544224
Name:JOHNSON, JACQLYN DAWN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JACQLYN
Middle Name:DAWN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1629 FRANCIS HAMMOND PKWY
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-3915
Mailing Address - Country:US
Mailing Address - Phone:202-495-1581
Mailing Address - Fax:
Practice Address - Street 1:1350 CONNECTICUT AVE NW STE 612
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-1735
Practice Address - Country:US
Practice Address - Phone:202-495-1581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-28
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1001330103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical