Provider Demographics
NPI:1467810846
Name:JOHNSON, NYKIA E (LLPC)
Entity Type:Individual
Prefix:MS
First Name:NYKIA
Middle Name:E
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23900 FLORENCE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-3745
Mailing Address - Country:US
Mailing Address - Phone:313-535-1019
Mailing Address - Fax:313-535-1019
Practice Address - Street 1:26847 GRAND RIVER AVE
Practice Address - Street 2:STE. 20
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48240-1544
Practice Address - Country:US
Practice Address - Phone:313-535-1019
Practice Address - Fax:313-535-1019
Is Sole Proprietor?:No
Enumeration Date:2016-02-01
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014990101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional