Provider Demographics
NPI:1750861027
Name:JOHNSON, BUNNY REA (LLMSW)
Entity Type:Individual
Prefix:MS
First Name:BUNNY
Middle Name:REA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-3681
Mailing Address - Country:US
Mailing Address - Phone:269-323-1954
Mailing Address - Fax:269-276-0201
Practice Address - Street 1:625 HARRISON ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-3681
Practice Address - Country:US
Practice Address - Phone:269-323-1954
Practice Address - Fax:269-276-0201
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801103169101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)