Individual ProviderMadison Samantha JohnsonCounselorBehavioral Health & Social Service ProvidersPractice Address711 State Ave NE, Olympia, WA 98506-3984(360) 481-4565PECOS EnrollmentBased on the most recent information from CMS, provider Madison Samantha Johnson does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1609494830Provider TypeIndividualFull NameJohnson, Madison SamanthaGenderFemaleSole ProprietorYesEnumeration Date7/14/2020Last Updated6/1/2021Contact InformationPractice LocationPractice Address711 State Ave NE, Olympia, WA 98506-3984Phone(360) 481-4565FaxUnlisted FaxMailing LocationMailing Address711 State Ave NE, Olympia, WA 98506-3984PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode101Y00000XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseCG61177156WashingtonCode101YM0800XDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseUnlisted Issuer