Provider Demographics
NPI:1427732387
Name:JOHNSON, ANGELICA SIMONE (SOCIAL WORK THERAPIS)
Entity type:Individual
Prefix:MS
First Name:ANGELICA
Middle Name:SIMONE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:SOCIAL WORK THERAPIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 S EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-3311
Mailing Address - Country:US
Mailing Address - Phone:989-667-9661
Mailing Address - Fax:
Practice Address - Street 1:2548 JULIANNE DR
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-3029
Practice Address - Country:US
Practice Address - Phone:989-577-9632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511165801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical