Provider Demographics
NPI:1265724009
Name:JOHNSON, BROOKE LORI (LCSW)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:LORI
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:LORI
Other - Last Name:ANDREWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:136 N PARK DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-2621
Mailing Address - Country:US
Mailing Address - Phone:301-661-3669
Mailing Address - Fax:
Practice Address - Street 1:10615 JUDICIAL DR STE 301
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7501
Practice Address - Country:US
Practice Address - Phone:703-424-0410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-12
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040072931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical