Provider Demographics
NPI:1053785758
Name:JOHNSON, KATHY L (QMHP A QMHP C)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:QMHP A QMHP C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1535 MT VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-3511
Mailing Address - Country:US
Mailing Address - Phone:757-409-2851
Mailing Address - Fax:
Practice Address - Street 1:4009 SCHOONER TRL
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-3217
Practice Address - Country:US
Practice Address - Phone:757-409-2851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-18
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0732004768101Y00000X
171M00000X, 172V00000X
VA0709025903101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker