Provider Demographics
NPI:1295009421
Name:JOHNSON, LYNNE (LCSW-C,LCSW,SAP, NCA)
Entity Type:Individual
Prefix:MS
First Name:LYNNE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW-C,LCSW,SAP, NCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:484 KEY WEST ST
Mailing Address - Street 2:
Mailing Address - City:MONETA
Mailing Address - State:VA
Mailing Address - Zip Code:24121-3360
Mailing Address - Country:US
Mailing Address - Phone:540-855-8793
Mailing Address - Fax:540-524-9027
Practice Address - Street 1:400 SCRUGGS RD
Practice Address - Street 2:SUITE 400
Practice Address - City:MONETA
Practice Address - State:VA
Practice Address - Zip Code:24121-2577
Practice Address - Country:US
Practice Address - Phone:540-855-8793
Practice Address - Fax:540-524-9027
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-06
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710000262101YA0400X
VA09040083471041C0700X
MD160181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)