Provider Demographics
NPI:1033727110
Name:JOHNSON, ABIGAIL SUZANNE (LMSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ABIGAIL
Middle Name:SUZANNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMSW, LCSW
Other - Prefix:MISS
Other - First Name:ABIGAIL
Other - Middle Name:SUZANNE
Other - Last Name:HOEKSTRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 MICHIGAN ST NE # MC845
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7751 BYRON CENTER AVE SW STE A
Practice Address - Street 2:
Practice Address - City:BYRON CENTER
Practice Address - State:MI
Practice Address - Zip Code:49315-8001
Practice Address - Country:US
Practice Address - Phone:616-878-3321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010916291041C0700X
IN34008857A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical