Healthcare Provider Details

I. General information

NPI: 1003142829
Provider Name (Legal Business Name): MARIJA SUNJKIC JOHNSON MA, LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIJA SUNJKIC MA, LPC, NCC

II. Dates (important events)

Enumeration Date: 10/29/2009
Last Update Date: 04/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 MAIN ST
SAINT JOSEPH MI
49085-1426
US

IV. Provider business mailing address

PO BOX 679
SAINT JOSEPH MI
49085-0679
US

V. Phone/Fax

Practice location:
  • Phone: 269-985-2000
  • Fax: 269-985-2002
Mailing address:
  • Phone: 269-985-2000
  • Fax: 269-985-2002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401011543
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6401011543
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: