person
Marcus Tyrone Johnson
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Suffolk, Virginia
NPI 1922880145

Marcus Tyrone Johnson is a Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility based in Suffolk, VA. Marcus Tyrone Johnson practices in Suffolk, VA. The NPI Number for Marcus Tyrone Johnson is 1922880145 and holds a License No. 7924 (Virginia).

The current practice location address for Marcus Tyrone Johnson is 6226 Heather Glen Dr, Suffolk, VA and can be reached out via phone at 757-374-1741.

Location: 6226 Heather Glen Dr, Suffolk, VA, 23435-3133
person
Provider Profile Details
NPI Number
1922880145
Provider Name
Marcus Tyrone Johnson
Credential
Provider Entity Type
Individual
Gender
Male
Address
6226 Heather Glen Dr, Suffolk, VA, 23435-3133
Phone Number
757-374-1741
Fax Number
Provider Enumeration Date
10/23/2023
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
6226 Heather Glen Dr
City
State
Zip
23435-3133
Phone Number
757-374-1741
Fax Number
person
Provider Business Mailing Address Details
Address
6226 Heather Glen Dr
City
State
Zip
23435-3133
Phone Number
757-374-1741
Fax Number
person
Provider's Taxonomy Details 1
Type
Residential Treatment Facilities
Classification
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Speciality
-
Taxonomy
License No.
7924 (Virginia)
Definition
A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.
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