Provider Demographics
NPI:1174104608
Name:JOHNSON, CHRISTINA JAMAICA (MED)
Entity type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:JAMAICA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 N SYCAMORE ST APT 308
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23803-3264
Mailing Address - Country:US
Mailing Address - Phone:919-937-8284
Mailing Address - Fax:
Practice Address - Street 1:92 MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-3366
Practice Address - Country:US
Practice Address - Phone:703-997-6641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-16
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010536101YM0800X
VA0704011925101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health