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General NPI Number Information
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NPI Number | 1841729746
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Entity Type | Individual
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Provider Name | EVYNN MARIA JOHNSON LMSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/06/2017
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Last Update Date | 10/20/2020
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Provider Practice Location Address
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Address Line | 2033 KOLO RD
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City | KILAUEA
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State | HI
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Zip | 96754-5563
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Country | US
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Telephone | 231-206-3686
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Fax |
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Provider Business Mailing Address
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Address Line | 3995 STAMFORD DR
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City | NORTON SHORES
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State | MI
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Zip | 49441-5037
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Country | US
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Telephone | 231-206-3686
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801094237
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License Number State | MI
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