Healthcare Provider Details

I. General information

NPI: 1679149017
Provider Name (Legal Business Name): SHAMIA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33464 SCHOENHERR RD STE 180
STERLING HEIGHTS MI
48312-6392
US

IV. Provider business mailing address

33464 SCHOENHERR RD STE 180
STERLING HEIGHTS MI
48312-6392
US

V. Phone/Fax

Practice location:
  • Phone: 586-999-5971
  • Fax: 248-712-4381
Mailing address:
  • Phone: 586-999-5971
  • Fax: 248-712-4381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-60704
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-17-45847
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: