Provider Demographics
NPI:1316062052
Name:INNISS-JOHNSON, JOY ELIZABETH (LPC, CRC, CAAC, CCS)
Entity type:Individual
Prefix:MRS
First Name:JOY
Middle Name:ELIZABETH
Last Name:INNISS-JOHNSON
Suffix:
Gender:F
Credentials:LPC, CRC, CAAC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4646 JOHN R. ROAD
Mailing Address - Street 2:JOHNSON D. DINGELL VA MEDICAL CENTER - MENTAL HEALTH
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2410
Mailing Address - Country:US
Mailing Address - Phone:313-576-1000
Mailing Address - Fax:313-576-1074
Practice Address - Street 1:4646 JOHN R. ROAD
Practice Address - Street 2:JOHN D. DINGELL VA MEDICAL CENTER - MENTAL HEALTH
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2410
Practice Address - Country:US
Practice Address - Phone:313-576-1000
Practice Address - Fax:313-576-1074
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007295101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1366491136OtherMENTAL HEALTH
MI1366491136OtherJOHN D. DINGELL VA MEDICAL CENTER