Provider Demographics
NPI:1861084212
Name:JOHNS, ANGELA
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:JOHNS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14407 JUSTICE RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-6875
Mailing Address - Country:US
Mailing Address - Phone:804-924-9260
Mailing Address - Fax:804-464-4919
Practice Address - Street 1:14407 JUSTICE RD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-6875
Practice Address - Country:US
Practice Address - Phone:804-924-9260
Practice Address - Fax:804-464-4919
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-08
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133002324103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst