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General NPI Number Information
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NPI Number | 1144261892
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Entity Type | Individual
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Provider Name | SANDRA FAYE JOHNSON MSW
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Gender | Female
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Dates
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Enumeration Date | 06/10/2006
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 31000 LAHSER RD SUITE 8
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City | BEVERLY HILLS
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State | MI
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Zip | 48025-4847
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Country | US
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Telephone | 248-723-6626
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Fax | 248-723-9499
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Provider Business Mailing Address
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Address Line | 24255 W 13 MILE RD. STE 280
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City | BINGHAM FARMS
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State | MI
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Zip | 48025
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Country | US
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Telephone | 248-731-7129
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Fax | 248-723-3901
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 4101005743
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801013199
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License Number State | MI
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