Healthcare Provider Details

I. General information

NPI: 1457275018
Provider Name (Legal Business Name): KATHERINE M JOHNSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29532 SOUTHFIELD RD STE 115
SOUTHFIELD MI
48076-2023
US

IV. Provider business mailing address

411 EISSMAN RD APT 25
LEESVILLE LA
71446-5484
US

V. Phone/Fax

Practice location:
  • Phone: 734-892-1146
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KATHERINE M. JOHNSON
Title or Position: SOCIAL WORKER/THERAPIST
Credential: LMSW-C
Phone: 734-892-1146