Provider Demographics
NPI:1942225529
Name:JOHNSON, JUDITH LYNN (PHD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:LYNN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9702 GAYTON RD
Mailing Address - Street 2:#181
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23238-4907
Mailing Address - Country:US
Mailing Address - Phone:804-741-7500
Mailing Address - Fax:804-741-7900
Practice Address - Street 1:9702 GAYTON RD
Practice Address - Street 2:#181
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23238-4907
Practice Address - Country:US
Practice Address - Phone:804-741-7500
Practice Address - Fax:804-741-7900
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002693103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010174414Medicaid
VA179390OtherBC
VA007821C90Medicare PIN