Provider Demographics
NPI:1598536070
Name:JOHNSON-LYMAN, WYNSTON (RBT)
Entity Type:Individual
Prefix:
First Name:WYNSTON
Middle Name:
Last Name:JOHNSON-LYMAN
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1964 GALLOWS RD STE 280
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3877
Mailing Address - Country:US
Mailing Address - Phone:571-533-3456
Mailing Address - Fax:855-832-0430
Practice Address - Street 1:1964 GALLOWS RD STE 280
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3877
Practice Address - Country:US
Practice Address - Phone:571-533-3456
Practice Address - Fax:855-832-0430
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-23-285060106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician