Provider Demographics
NPI:1548416464
Name:JOHNSON, CHRISTINA LYNNE (MA, LLP)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:LYNNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47818 VAN DYKE AVENUE
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48317
Mailing Address - Country:US
Mailing Address - Phone:586-323-3620
Mailing Address - Fax:586-323-3568
Practice Address - Street 1:47818 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48317-3373
Practice Address - Country:US
Practice Address - Phone:586-323-3620
Practice Address - Fax:586-323-3568
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013793103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI20576OtherBCBSM SUBSTANCE ABUSE
MI1705289Medicaid
MI028363OtherVALUE OPTIONS
MI7509105060OtherBCBSM
MI5266701OtherAETNA