Healthcare Provider Details

I. General information

NPI: 1710897947
Provider Name (Legal Business Name): CHRISTA LYNN JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44001 GARFIELD RD
CLINTON TOWNSHIP MI
48038-1100
US

IV. Provider business mailing address

28949 JOAN ST
SAINT CLAIR SHORES MI
48081-1035
US

V. Phone/Fax

Practice location:
  • Phone: 586-228-3529
  • Fax:
Mailing address:
  • Phone: 586-804-1849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6851118387
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: