Provider Demographics
NPI:1215707237
Name:JOHNSON, LEAH JEAN (MSW, LMSW-C)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:JEAN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSW, LMSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 E CESAR E CHAVEZ AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48906-4447
Mailing Address - Country:US
Mailing Address - Phone:407-575-1910
Mailing Address - Fax:
Practice Address - Street 1:6960 ORCHARD LAKE RD STE 202
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4519
Practice Address - Country:US
Practice Address - Phone:248-985-9942
Practice Address - Fax:248-221-1775
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011181001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical