Provider Demographics
NPI:1861000937
Name:JOHNSON, VALERIE KING (PCA)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:KING
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PCA
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:KING
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PCA
Mailing Address - Street 1:506 STRATFORD CIR
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:VA
Mailing Address - Zip Code:22508-5322
Mailing Address - Country:US
Mailing Address - Phone:540-406-0783
Mailing Address - Fax:540-412-0886
Practice Address - Street 1:506 STRATFORD CIR
Practice Address - Street 2:
Practice Address - City:LAKE OF WOODS
Practice Address - State:VA
Practice Address - Zip Code:22508-5322
Practice Address - Country:US
Practice Address - Phone:540-406-0783
Practice Address - Fax:540-412-0886
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty