Provider Demographics
NPI:1154159754
Name:JOHNSON, CARLEAH (PMHNP)
Entity type:Individual
Prefix:MRS
First Name:CARLEAH
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 MARKHAM ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-4229
Mailing Address - Country:US
Mailing Address - Phone:484-574-6939
Mailing Address - Fax:
Practice Address - Street 1:2010 GREENBRIER RD.
Practice Address - Street 2:J
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2619
Practice Address - Country:US
Practice Address - Phone:758-413-5444
Practice Address - Fax:757-413-5440
Is Sole Proprietor?:No
Enumeration Date:2024-07-24
Last Update Date:2024-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024190700363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health