Provider Demographics
NPI:1104015494
Name:JOHNSON, WILLIAM EDWARD-JOSEPH (BS, FAODP)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:EDWARD-JOSEPH
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:BS, FAODP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 GLENDALE ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48203-3274
Mailing Address - Country:US
Mailing Address - Phone:313-993-4700
Mailing Address - Fax:
Practice Address - Street 1:91 GLENDALE ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:MI
Practice Address - Zip Code:48203-3274
Practice Address - Country:US
Practice Address - Phone:313-993-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)