Provider Demographics
NPI:1225603277
Name:JOHNSON, ROBIN LORETTA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:LORETTA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13771 LOWE ST
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-3210
Mailing Address - Country:US
Mailing Address - Phone:703-662-1399
Mailing Address - Fax:
Practice Address - Street 1:13771 LOWE ST
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-3210
Practice Address - Country:US
Practice Address - Phone:410-493-6252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD069121041C0700X
VA09040089711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical