Provider Demographics
NPI:1528497286
Name:JOHNSON, JORDAN R (MS, RESIDENT IN MFT)
Entity type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:R
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MS, RESIDENT IN MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 S ALFRED ST
Mailing Address - Street 2:SUITE 9
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-3049
Mailing Address - Country:US
Mailing Address - Phone:571-766-8014
Mailing Address - Fax:
Practice Address - Street 1:121 S ALFRED ST
Practice Address - Street 2:SUITE 9
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-3049
Practice Address - Country:US
Practice Address - Phone:571-766-8014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist