Provider Demographics
NPI:1588828438
Name:COLTON, JOHNNIE CRAIG (MA,LLP)
Entity Type:Individual
Prefix:MR
First Name:JOHNNIE
Middle Name:CRAIG
Last Name:COLTON
Suffix:
Gender:M
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 1:4606 SEEGER ST
Mailing Address - Street 2:
Mailing Address - City:CASS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48726-1229
Mailing Address - Country:US
Mailing Address - Phone:989-872-5466
Mailing Address - Fax:
Practice Address - Street 1:1240 W SANILAC RD
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:MI
Practice Address - Zip Code:48471-9654
Practice Address - Country:US
Practice Address - Phone:810-648-3248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007335103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical