Healthcare Provider Details

I. General information

NPI: 1821486853
Provider Name (Legal Business Name): JOSEPH ANTHONY JOHNSON B.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2014
Last Update Date: 12/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2091 PROFESSIONAL DR STE D
FLINT MI
48532-3657
US

IV. Provider business mailing address

2097 WHISPERING WATERS PASS
FLUSHING MI
48433-1789
US

V. Phone/Fax

Practice location:
  • Phone: 810-732-1652
  • Fax: 810-732-1735
Mailing address:
  • Phone: 810-867-2186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: