Provider Demographics
NPI:1447745641
Name:VICK JOHNS COUNSELING AND CONSULTING
Entity Type:Organization
Organization Name:VICK JOHNS COUNSELING AND CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MBA
Authorized Official - Phone:571-383-6008
Mailing Address - Street 1:16354 RUSTY RUDDER DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-6357
Mailing Address - Country:US
Mailing Address - Phone:703-680-0124
Mailing Address - Fax:703-441-1400
Practice Address - Street 1:17521 TRIPOLI BLVD
Practice Address - Street 2:
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22026-2239
Practice Address - Country:US
Practice Address - Phone:703-441-8000
Practice Address - Fax:703-441-1400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904005349261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)