Healthcare Provider Details

I. General information

NPI: 1528657251
Provider Name (Legal Business Name): JULIUS D JOHNSON II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2021
Last Update Date: 01/17/2021
Certification Date: 01/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2081 W GRAND BLVD
DETROIT MI
48208-1196
US

IV. Provider business mailing address

2081 W GRAND BLVD
DETROIT MI
48208-1196
US

V. Phone/Fax

Practice location:
  • Phone: 313-895-0500
  • Fax: 313-895-9503
Mailing address:
  • Phone: 313-895-0500
  • Fax: 313-895-9503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: