Provider Demographics
NPI:1649398215
Name:JOHNSON, DEBORAH ANGELA (LLP)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:ANGELA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:MRS
Other - First Name:DEBORAH
Other - Middle Name:ANGELA
Other - Last Name:HOOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CAADC
Mailing Address - Street 1:20419 SCHAEFER HWY
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-1553
Mailing Address - Country:US
Mailing Address - Phone:313-918-7233
Mailing Address - Fax:
Practice Address - Street 1:20419 SCHAEFER HWY
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-1553
Practice Address - Country:US
Practice Address - Phone:313-918-7233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005640103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist