Healthcare Provider Details

I. General information

NPI: 1942214101
Provider Name (Legal Business Name): DELIA JOHNSON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 09/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1522 JOY AVE
JACKSON MI
49203-1933
US

IV. Provider business mailing address

1522 JOY AVE
JACKSON MI
49203-1933
US

V. Phone/Fax

Practice location:
  • Phone: 517-782-2551
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801015173
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: