Provider Demographics
NPI:1245863505
Name:JOHNSON, SUSAN DAVIS (LBA)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:DAVIS
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:752 TRAINING CENTER RD
Mailing Address - Street 2:
Mailing Address - City:HILLSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24343-5656
Mailing Address - Country:US
Mailing Address - Phone:762-371-3472
Mailing Address - Fax:
Practice Address - Street 1:752 TRAINING CENTER RD
Practice Address - Street 2:
Practice Address - City:HILLSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24343-5656
Practice Address - Country:US
Practice Address - Phone:762-371-3472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-14
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133001627103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst