Provider Demographics
NPI:1821486853
Name:JOHNSON, JOSEPH ANTHONY (BA)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ANTHONY
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2097 WHISPERING WATERS PASS
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433-1789
Mailing Address - Country:US
Mailing Address - Phone:810-867-2186
Mailing Address - Fax:
Practice Address - Street 1:2091 PROFESSIONAL DR STE D
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3657
Practice Address - Country:US
Practice Address - Phone:810-732-1652
Practice Address - Fax:810-732-1735
Is Sole Proprietor?:No
Enumeration Date:2014-12-29
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)