Provider Demographics
NPI:1851572424
Name:JOHNSON-MCROY, PAMIELY (CMSW)
Entity Type:Individual
Prefix:MRS
First Name:PAMIELY
Middle Name:
Last Name:JOHNSON-MCROY
Suffix:
Gender:F
Credentials:CMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 E GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-3534
Mailing Address - Country:US
Mailing Address - Phone:313-571-5104
Mailing Address - Fax:586-771-2037
Practice Address - Street 1:560 E. GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-3534
Practice Address - Country:US
Practice Address - Phone:313-506-9556
Practice Address - Fax:586-771-2037
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-23
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010658241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical