Provider Demographics
NPI:1649503244
Name:JOHNSON-SNYDER, ELAINE
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:JOHNSON-SNYDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 OLD LYNCHBURG RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-6500
Mailing Address - Country:US
Mailing Address - Phone:434-972-1800
Mailing Address - Fax:434-970-5180
Practice Address - Street 1:96 MAIN STREET
Practice Address - Street 2:
Practice Address - City:LOVINGSTON
Practice Address - State:VA
Practice Address - Zip Code:22949
Practice Address - Country:US
Practice Address - Phone:434-972-1800
Practice Address - Fax:434-970-5180
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004945018Medicaid