Healthcare Provider Details

I. General information

NPI: 1538921663
Provider Name (Legal Business Name): ALICIA JOHNSON COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2024
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 LAKE EASTBROOK BLVD SE STE 220
GRAND RAPIDS MI
49546-5940
US

IV. Provider business mailing address

915 CHERRY ST SE LOWR
GRAND RAPIDS MI
49506-1403
US

V. Phone/Fax

Practice location:
  • Phone: 616-279-8311
  • Fax:
Mailing address:
  • Phone: 810-772-8875
  • Fax:

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: ALICIA A JOHNSON
Title or Position: LICENSED MASTER SOCIAL WORKER
Credential: LMSW
Phone: 810-772-8875