Provider Demographics
NPI:1639430150
Name:CAROL A JOHNS PHD PC
Entity type:Organization
Organization Name:CAROL A JOHNS PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:JOHNS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:586-254-2994
Mailing Address - Street 1:11111 HALL RD STE 201
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:MI
Mailing Address - Zip Code:48317-5799
Mailing Address - Country:US
Mailing Address - Phone:586-254-2994
Mailing Address - Fax:586-791-0419
Practice Address - Street 1:11111 HALL RD STE 201
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:MI
Practice Address - Zip Code:48317-5799
Practice Address - Country:US
Practice Address - Phone:586-254-2994
Practice Address - Fax:586-791-0419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008454103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM99350Medicare PIN