Provider Demographics
NPI:1144182502
Name:JOHNSON, XAVIANA RASHANEL
Entity type:Individual
Prefix:
First Name:XAVIANA
Middle Name:RASHANEL
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2367 N EARL RUDDER FWY
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77803-5188
Mailing Address - Country:US
Mailing Address - Phone:979-218-2199
Mailing Address - Fax:
Practice Address - Street 1:2367 N EARL RUDDER FWY
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77803-5188
Practice Address - Country:US
Practice Address - Phone:979-218-2199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-24
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician