Provider Demographics
NPI:1326339276
Name:JOHNSON, JOHN R III (MS)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:JOHNSON
Suffix:III
Gender:M
Credentials:MS
Other - Prefix:MR
Other - First Name:JOHN
Other - Middle Name:R
Other - Last Name:JOHNSON
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:13800 COPPERMINE RD
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-6163
Mailing Address - Country:US
Mailing Address - Phone:718-215-5311
Mailing Address - Fax:718-865-5165
Practice Address - Street 1:13800 COPPERMINE RD
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-6163
Practice Address - Country:US
Practice Address - Phone:718-215-5311
Practice Address - Fax:718-865-5165
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-27
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-25-445440106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician