Provider Demographics
NPI:1750156881
Name:JOHNSON, DAIJAH (PTCB, LCPC, LMHC)
Entity type:Individual
Prefix:
First Name:DAIJAH
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PTCB, LCPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 PINETREE DR APT P3
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23803-7968
Mailing Address - Country:US
Mailing Address - Phone:434-368-2332
Mailing Address - Fax:
Practice Address - Street 1:3100 PINETREE DR APT P3
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-7968
Practice Address - Country:US
Practice Address - Phone:434-368-2332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TH0004X, 176B00000X, 101YM0800X
VA103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No176B00000XOther Service ProvidersMidwife
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling