Provider Demographics
NPI:1083743389
Name:JOHNSON, CHRISTINA DOROTHY (MA)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:DOROTHY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 W HOLMES RD
Mailing Address - Street 2:SUITE 227
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-0426
Mailing Address - Country:US
Mailing Address - Phone:517-882-6159
Mailing Address - Fax:517-339-5154
Practice Address - Street 1:913 W HOLMES RD
Practice Address - Street 2:SUITE 227
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-0426
Practice Address - Country:US
Practice Address - Phone:517-882-6159
Practice Address - Fax:517-339-5154
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401006187101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health