Provider Demographics
NPI:1235869660
Name:JOHNSON, SHAINA (LLMSW)
Entity Type:Individual
Prefix:
First Name:SHAINA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 JENNER DR
Mailing Address - Street 2:
Mailing Address - City:ALLEGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49010-1517
Mailing Address - Country:US
Mailing Address - Phone:269-686-5124
Mailing Address - Fax:833-329-6632
Practice Address - Street 1:540 JENNER DR
Practice Address - Street 2:
Practice Address - City:ALLEGAN
Practice Address - State:MI
Practice Address - Zip Code:49010-1517
Practice Address - Country:US
Practice Address - Phone:269-686-5124
Practice Address - Fax:269-673-2738
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1235869660104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker