Provider Demographics
NPI:1639367618
Name:JOHNSON, MICHELLE L (MSW, CADC 2)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSW, CADC 2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 THOMAS DR APT 1
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-1634
Mailing Address - Country:US
Mailing Address - Phone:415-215-6542
Mailing Address - Fax:
Practice Address - Street 1:914 MISSION AVE FL 3
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-6106
Practice Address - Country:US
Practice Address - Phone:415-457-6964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker