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General NPI Number Information
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NPI Number | 1639459092
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Entity Type | Individual
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Provider Name | FELICIA ANN JOHNSON LPC
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Gender | Female
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Dates
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Enumeration Date | 08/17/2011
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 24715 LITTLE MACK AVE STE 200
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48080-3207
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Country | US
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Telephone | 586-777-9000
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Fax |
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Provider Business Mailing Address
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Address Line | 24715 LITTLE MACK AVE
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48080-3207
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Country | US
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Telephone | 586-777-9000
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 64010111967
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6401011967
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License Number State | MI
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