Provider Demographics
NPI:1114672375
Name:JOHNSON-CALLAGHAN, ALYSHA NICOLE (RBT)
Entity Type:Individual
Prefix:
First Name:ALYSHA
Middle Name:NICOLE
Last Name:JOHNSON-CALLAGHAN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:ALYSHA
Other - Middle Name:NICHOLE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16925 ABILITY WAY
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-9325
Mailing Address - Country:US
Mailing Address - Phone:616-935-7606
Mailing Address - Fax:616-935-7607
Practice Address - Street 1:16925 ABILITY WAY
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-9325
Practice Address - Country:US
Practice Address - Phone:616-935-7606
Practice Address - Fax:616-935-7607
Is Sole Proprietor?:No
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1942689708OtherTHE SHORELINE CENTER, LLC