Provider Demographics
NPI:1588747869
Name:JOHNSON, SHARLENE PATRICIA (PHD)
Entity type:Individual
Prefix:DR
First Name:SHARLENE
Middle Name:PATRICIA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 FOREST HILL AVE
Mailing Address - Street 2:SUITE C2
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-6867
Mailing Address - Country:US
Mailing Address - Phone:804-323-3262
Mailing Address - Fax:804-330-3827
Practice Address - Street 1:9200 FOREST HILL AVE
Practice Address - Street 2:SUITE C2
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-6867
Practice Address - Country:US
Practice Address - Phone:804-323-3262
Practice Address - Fax:804-330-3827
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001104103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAR61283Medicare UPIN