Provider Demographics
NPI:1376187963
Name:JOHNSON, TEKA CHRISTIANE (LCSW)
Entity Type:Individual
Prefix:
First Name:TEKA
Middle Name:CHRISTIANE
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 1:13926 HULL STREET ROAD PMB 1064
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-1886
Mailing Address - Country:US
Mailing Address - Phone:804-404-3717
Mailing Address - Fax:
Practice Address - Street 1:999 WATERSIDE DRIVE
Practice Address - Street 2:SUITE 2525
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510
Practice Address - Country:US
Practice Address - Phone:844-843-7279
Practice Address - Fax:804-414-7489
Is Sole Proprietor?:No
Enumeration Date:2019-11-06
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040102911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical