Provider Demographics
NPI:1932497427
Name:JOHNSON, REBECCA ANN (BCABA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 WILLIAM ST
Mailing Address - Street 2:UPPER FLOOR
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-5549
Mailing Address - Country:US
Mailing Address - Phone:540-368-8087
Mailing Address - Fax:540-368-8059
Practice Address - Street 1:1602 WILLIAM ST
Practice Address - Street 2:UPPER FLOOR
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-5549
Practice Address - Country:US
Practice Address - Phone:540-368-8087
Practice Address - Fax:540-368-8059
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0-11-4103103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst