Provider Demographics
NPI:1689719593
Name:JOHNS, MARY CATHERINE (LMSW CACT LMFT)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:CATHERINE
Last Name:JOHNS
Suffix:
Gender:F
Credentials:LMSW CACT LMFT
Other - Prefix:MS
Other - First Name:MARY CAY
Other - Middle Name:
Other - Last Name:JOHNS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW CACI LMFT
Mailing Address - Street 1:23909 EDWARD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-1223
Mailing Address - Country:US
Mailing Address - Phone:313-563-3407
Mailing Address - Fax:313-563-7415
Practice Address - Street 1:23909 EDWARD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48128-1223
Practice Address - Country:US
Practice Address - Phone:313-563-3407
Practice Address - Fax:313-563-7415
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICACI100774101YA0400X
MILMSW68010029901041C0700X
MILMFT4101005140106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist