Healthcare Provider Details

I. General information

NPI: 1851139620
Provider Name (Legal Business Name): DAMITA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DAMITA JOHNSON-EL-BEY

II. Dates (important events)

Enumeration Date: 07/17/2024
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 W FORT ST UNIT 441846
DETROIT MI
48244-3575
US

IV. Provider business mailing address

1401 W FORT ST UNIT 441846
DETROIT MI
48244-3575
US

V. Phone/Fax

Practice location:
  • Phone: 313-492-9437
  • Fax:
Mailing address:
  • Phone: 313-492-9437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License NumberJ525135122103
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374K00000X
TaxonomyReligious Nonmedical Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: