Individual provider · Type 1 NPI
Marcus Tyrone Johnson
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Suffolk, VA
Practice location
6226 Heather Glen Dr
Suffolk, VA 23435-3133
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility Primary | 320900000X | 7924 (VA) |
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility: A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.
Another provider at this address
About NPI 1922880145
Marcus Tyrone Johnson's National Provider Identifier is 1922880145, issued on Oct 23, 2023. The primary taxonomy on file is Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility (320900000X), and the practice location is in Suffolk, VA. The record was last updated on Oct 23, 2023.