Provider Demographics
NPI:1861515363
Name:JOHNSON, ELIZABETH MARIE (MA,MSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA,MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4890 OJIBWAY TRL
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-9782
Mailing Address - Country:US
Mailing Address - Phone:989-723-1120
Mailing Address - Fax:989-729-6506
Practice Address - Street 1:802 W KING ST
Practice Address - Street 2:SUITE P
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-2100
Practice Address - Country:US
Practice Address - Phone:989-723-1120
Practice Address - Fax:989-729-6506
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002288103TC0700X
MI68010191501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical