Healthcare Provider Details

I. General information

NPI: 1427388214
Provider Name (Legal Business Name): CHERINA DAWN JOHNSON STAPLES LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2009
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 68TH ST SE
GRAND RAPIDS MI
49548-6927
US

IV. Provider business mailing address

315 HAYWOOD DR
KATHLEEN GA
31047-3117
US

V. Phone/Fax

Practice location:
  • Phone: 616-559-5896
  • Fax:
Mailing address:
  • Phone: 209-598-5861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC006376
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401222308
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401222308
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: