Provider Demographics
NPI:1033939285
Name:JOHNSON, KEYONDA SHAYLA (LPC RESIDENT)
Entity type:Individual
Prefix:MISS
First Name:KEYONDA
Middle Name:SHAYLA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPC RESIDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 BELSPRING RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-4612
Mailing Address - Country:US
Mailing Address - Phone:804-252-0126
Mailing Address - Fax:
Practice Address - Street 1:3800 BELSPRING RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-4612
Practice Address - Country:US
Practice Address - Phone:804-252-0126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-14
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA212003001251S00000X
VA0704016147101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No251S00000XAgenciesCommunity/Behavioral Health