Provider Demographics
NPI:1609118637
Name:JOHNSON, ALEXIS (LMSW, CADC)
Entity Type:Individual
Prefix:MS
First Name:ALEXIS
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 ELECTRIC AVE
Mailing Address - Street 2:STE A
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-6589
Mailing Address - Country:US
Mailing Address - Phone:810-357-1725
Mailing Address - Fax:810-982-9802
Practice Address - Street 1:2609 ELECTRIC AVE
Practice Address - Street 2:STE A
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-6589
Practice Address - Country:US
Practice Address - Phone:810-357-1725
Practice Address - Fax:810-982-9802
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-16
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2-01129101YA0400X
MI68010912211041C0700X
MI1041C0700X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)