Provider Demographics
NPI:1780705442
Name:JOHNSON, CAROL ANN (SOCIAL WORKER)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:832 FOREST HILL AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2326
Mailing Address - Country:US
Mailing Address - Phone:616-940-9001
Mailing Address - Fax:616-940-7355
Practice Address - Street 1:832 FOREST HILL AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2326
Practice Address - Country:US
Practice Address - Phone:616-940-9001
Practice Address - Fax:616-940-7355
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICJ077444101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health