Provider Demographics
NPI:1316254675
Name:JOHNSON, VIRGINIA STANGELAND (MC)
Entity type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:STANGELAND
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3504 SW WEBSTER ST
Mailing Address - Street 2:#208
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98126-3272
Mailing Address - Country:US
Mailing Address - Phone:206-938-4643
Mailing Address - Fax:
Practice Address - Street 1:3504 SW WEBSTER ST
Practice Address - Street 2:#208
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126-3272
Practice Address - Country:US
Practice Address - Phone:206-938-4643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60152895101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health