Provider Demographics
NPI:1144261892
Name:JOHNSON, SANDRA FAYE (MSW)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:FAYE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24255 W 13 MILE RD.
Mailing Address - Street 2:STE 280
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025
Mailing Address - Country:US
Mailing Address - Phone:248-731-7129
Mailing Address - Fax:248-723-3901
Practice Address - Street 1:31000 LAHSER RD
Practice Address - Street 2:SUITE 8
Practice Address - City:BEVERLY HILLS
Practice Address - State:MI
Practice Address - Zip Code:48025-4847
Practice Address - Country:US
Practice Address - Phone:248-723-6626
Practice Address - Fax:248-723-9499
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101005743106H00000X
MI68010131991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist