Provider Demographics
NPI:1982942470
Name:JOHNSON ROBINSON, JERICIA VETISS (MED)
Entity Type:Individual
Prefix:MS
First Name:JERICIA
Middle Name:VETISS
Last Name:JOHNSON ROBINSON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:MS
Other - First Name:JERICIA
Other - Middle Name:VETISS
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:9842 LORI RD STE 201
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-6656
Mailing Address - Country:US
Mailing Address - Phone:804-362-7860
Mailing Address - Fax:
Practice Address - Street 1:9842 LORI RD STE 201
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-6656
Practice Address - Country:US
Practice Address - Phone:804-362-7860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-18
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006648101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health