Healthcare Provider Details

I. General information

NPI: 1255465258
Provider Name (Legal Business Name): ROBERT GERARD JOHNSON SR. LPC, SPADA, CAAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7791 BYRON CENTER AVE SW
BYRON CENTER MI
49315-8412
US

IV. Provider business mailing address

7791 BYRON CENTER AVE SW
BYRON CENTER MI
49315-8412
US

V. Phone/Fax

Practice location:
  • Phone: 616-499-4711
  • Fax: 888-336-9355
Mailing address:
  • Phone: 616-499-4711
  • Fax: 888-336-9355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401008579
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC-01218
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: