Healthcare Provider Details

I. General information

NPI: 1750836870
Provider Name (Legal Business Name): CHRISTINA ROELANE JOHNSON LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2016
Last Update Date: 08/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 E JOLLY RD STE 114
LANSING MI
48910-6820
US

IV. Provider business mailing address

812 E JOLLY RD STE 210 ATTN: DIANA SMITH
LANSING MI
48910-6821
US

V. Phone/Fax

Practice location:
  • Phone: 517-346-8112
  • Fax: 517-346-8291
Mailing address:
  • Phone: 517-346-8112
  • Fax: 517-346-8291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801099727
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: