Provider Demographics
NPI:1326189226
Name:JOHNSON, ANDREA MICHELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MICHELLE
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 1:10299 WOODMAN RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-4419
Mailing Address - Country:US
Mailing Address - Phone:804-727-8500
Mailing Address - Fax:804-727-8580
Practice Address - Street 1:9403 POCOHANTAS TRAIL
Practice Address - Street 2:
Practice Address - City:PROVIDENCE FORGE
Practice Address - State:VA
Practice Address - Zip Code:23140
Practice Address - Country:US
Practice Address - Phone:804-966-5959
Practice Address - Fax:804-966-5694
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040031171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2169315OtherMAMSI
VA272779-000OtherMAGELLAN
VA110331OtherANTHEM
VAO84784OtherOPTIMA
VA002257H71Medicare PIN