=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538921663
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALICIA JOHNSON COUNSELING SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2024
-----------------------------------------------------
Last Update Date | 03/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3501 LAKE EASTBROOK BLVD SE STE 220
-----------------------------------------------------
City | GRAND RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49546-5940
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-279-8311
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 915 CHERRY ST SE LOWR
-----------------------------------------------------
City | GRAND RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49506-1403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-772-8875
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED MASTER SOCIAL WORKER
-----------------------------------------------------
Name | ALICIA A JOHNSON
-----------------------------------------------------
Credential | LMSW
-----------------------------------------------------
Telephone | 810-772-8875
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------