Provider Demographics
NPI:1720457807
Name:VICK JOHNS COUNSELING & CONSULTING
Entity type:Organization
Organization Name:VICK JOHNS COUNSELING & CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:703-398-9381
Mailing Address - Street 1:16354 RUSTY RUDDER DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-6357
Mailing Address - Country:US
Mailing Address - Phone:703-398-9381
Mailing Address - Fax:703-680-0145
Practice Address - Street 1:16354 RUSTY RUDDER DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-6357
Practice Address - Country:US
Practice Address - Phone:703-398-9381
Practice Address - Fax:703-680-0145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-18
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904005349251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health