Healthcare Provider Details

I. General information

NPI: 1336561281
Provider Name (Legal Business Name): LINDA JOHNSON-MCCLENDON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2014
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45964 BRENTWOOD ST
MACOMB MI
48042-5410
US

IV. Provider business mailing address

45964 BRENTWOOD ST
MACOMB MI
48042-5410
US

V. Phone/Fax

Practice location:
  • Phone: 248-658-1116
  • Fax: 248-658-1120
Mailing address:
  • Phone: 248-658-1116
  • Fax: 248-658-1120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: