Healthcare Provider Details

I. General information

NPI: 1326689928
Provider Name (Legal Business Name): AMBER JOHNSON LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2019
Last Update Date: 10/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5303 S CEDAR ST
LANSING MI
48911-3800
US

IV. Provider business mailing address

PO BOX 30161
LANSING MI
48909-7661
US

V. Phone/Fax

Practice location:
  • Phone: 517-887-4305
  • Fax: 517-887-4440
Mailing address:
  • Phone: 517-702-3500
  • Fax: 517-484-5169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801103894
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: