Provider Demographics
NPI:1285312595
Name:JOHNSON, CHRISTINA M (BSPH, CBD-CPD, IBCLC)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:BSPH, CBD-CPD, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25151 DEQUINDRE RD LOT 67
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-4221
Mailing Address - Country:US
Mailing Address - Phone:734-224-5471
Mailing Address - Fax:
Practice Address - Street 1:905 W 11 MILE RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-3103
Practice Address - Country:US
Practice Address - Phone:734-224-5471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-06
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133NN1002X, 171400000X, 172V00000X, 174H00000X, 372600000X, 376K00000X, 372500000X
MI374J00000X
MIDP-CPS8305405300000X
L-313068174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No171400000XOther Service ProvidersHealth & Wellness Coach
No172V00000XOther Service ProvidersCommunity Health Worker
No174H00000XOther Service ProvidersHealth Educator
No372600000XNursing Service Related ProvidersAdult Companion
No374J00000XNursing Service Related ProvidersDoula
No376K00000XNursing Service Related ProvidersNurse's Aide
No372500000XNursing Service Related ProvidersChore Provider
No405300000XOther Service ProvidersPrevention Professional