Provider Demographics
NPI:1104180751
Name:MICHELLE C. JOHNSON L.C.S.W.
Entity Type:Organization
Organization Name:MICHELLE C. JOHNSON L.C.S.W.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:L.C.S.W. THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:C
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:302-893-9235
Mailing Address - Street 1:322 W 35TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19802-2639
Mailing Address - Country:US
Mailing Address - Phone:302-893-9235
Mailing Address - Fax:
Practice Address - Street 1:504 S CLAYTON ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-4211
Practice Address - Country:US
Practice Address - Phone:302-893-9235
Practice Address - Fax:302-655-4406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-28
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-00011561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty