Provider Demographics
NPI:1659117679
Name:JOHNSON, ANIYA
Entity type:Individual
Prefix:
First Name:ANIYA
Middle Name:
Last Name:JOHNSON
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 1:9720 CAPITAL CT
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-2044
Mailing Address - Country:US
Mailing Address - Phone:703-770-8060
Mailing Address - Fax:
Practice Address - Street 1:9720 CAPITAL CT
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-2044
Practice Address - Country:US
Practice Address - Phone:703-770-8060
Practice Address - Fax:703-748-2212
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-23-306703106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician