Provider Demographics
NPI:1679795637
Name:VIRGINIA JOHNSON PS
Entity type:Organization
Organization Name:VIRGINIA JOHNSON PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:425-347-7275
Mailing Address - Street 1:127 E INTERCITY AVE STE A
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-2732
Mailing Address - Country:US
Mailing Address - Phone:425-347-7275
Mailing Address - Fax:425-355-0626
Practice Address - Street 1:127 E INTERCITY AVE STE A
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-2732
Practice Address - Country:US
Practice Address - Phone:425-347-7275
Practice Address - Fax:425-355-0626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2927103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8856517Medicare ID - Type Unspecified