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General NPI Number Information
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NPI Number | 1558174060
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Entity Type | Individual
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Provider Name | CAITLIN LIAN XI-LE JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 01/29/2025
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 40 E FERRY ST
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City | DETROIT
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State | MI
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Zip | 48202-3802
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Country | US
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Telephone | 734-785-7705
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Fax |
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Provider Business Mailing Address
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Address Line | 11380 SHILLING DR
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City | STERLING HEIGHTS
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State | MI
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Zip | 48314-3553
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Country | US
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Telephone | 586-419-1276
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Fax |
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6362010102
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License Number State |
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