Provider Demographics
NPI:1396525093
Name:JOHNSON-KING, TRACEY DENISE (LPC-R)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:DENISE
Last Name:JOHNSON-KING
Suffix:
Gender:F
Credentials:LPC-R
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:DENISE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC-R
Mailing Address - Street 1:4000 SOLERA DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-4092
Mailing Address - Country:US
Mailing Address - Phone:804-591-8671
Mailing Address - Fax:866-622-7868
Practice Address - Street 1:4000 SOLERA DR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-4092
Practice Address - Country:US
Practice Address - Phone:804-591-8671
Practice Address - Fax:866-622-7868
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704010255101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health