Provider Demographics
NPI:1235546193
Name:CITTA MENTAL HEALTH SERVICES
Entity Type:Organization
Organization Name:CITTA MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:RACHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON MAIGA
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:734-799-3302
Mailing Address - Street 1:3300 WASHTENAW AVE
Mailing Address - Street 2:SUITE 295
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-4200
Mailing Address - Country:US
Mailing Address - Phone:734-799-3302
Mailing Address - Fax:
Practice Address - Street 1:3300 WASHTENAW AVE
Practice Address - Street 2:SUITE 295
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-4200
Practice Address - Country:US
Practice Address - Phone:734-799-3302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704286422363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty