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General NPI Number Information
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NPI Number | 1891586210
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Entity Type | Individual
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Provider Name | DOMINIQUE JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 05/15/2025
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Last Update Date | 05/15/2025
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Provider Practice Location Address
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Address Line | 4673 WASHTENAW AVE
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City | ANN ARBOR
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State | MI
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Zip | 48108-1301
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Country | US
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Telephone | 734-547-5009
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Fax |
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Provider Business Mailing Address
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Address Line | 1825 EILEEN ST
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City | YPSILANTI
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State | MI
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Zip | 48198-6239
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Country | US
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Telephone | 734-644-0685
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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