Healthcare Provider Details

I. General information

NPI: 1083743389
Provider Name (Legal Business Name): CHRISTINA DOROTHY JOHNSON MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 W HOLMES RD SUITE 227
LANSING MI
48910-0426
US

IV. Provider business mailing address

913 W HOLMES RD SUITE 227
LANSING MI
48910-0426
US

V. Phone/Fax

Practice location:
  • Phone: 517-882-6159
  • Fax: 517-339-5154
Mailing address:
  • Phone: 517-882-6159
  • Fax: 517-339-5154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401006187
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: