Provider Demographics
NPI:1215462023
Name:JOHNSON, ERICA M (MSW, MHRIR)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSW, MHRIR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 COLER RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-4627
Mailing Address - Country:US
Mailing Address - Phone:773-383-3123
Mailing Address - Fax:
Practice Address - Street 1:2385 S HURON PKWY
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-5171
Practice Address - Country:US
Practice Address - Phone:734-956-0051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-30
Last Update Date:2017-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011007391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical