Provider Demographics
NPI:1144506577
Name:JOHNSON, PAMELA CHRISTINE (MC LPC CAADC)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:CHRISTINE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MC LPC CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2885 HEALTH PKWY STE 1
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-8924
Mailing Address - Country:US
Mailing Address - Phone:989-772-9655
Mailing Address - Fax:989-773-1187
Practice Address - Street 1:2885 HEALTH PKWY STE 1
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-8924
Practice Address - Country:US
Practice Address - Phone:989-772-9655
Practice Address - Fax:989-773-1187
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010849101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional