Provider Demographics
NPI:1245440445
Name:JOHNSON, BARBARA QUEEN (LMSW)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:QUEEN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20955 VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2381
Mailing Address - Country:US
Mailing Address - Phone:248-227-8455
Mailing Address - Fax:
Practice Address - Street 1:20955 VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2381
Practice Address - Country:US
Practice Address - Phone:248-227-8455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010643701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical