Provider Demographics
NPI:1962525741
Name:JOHNSON, MARSHA M (CAC-1, LMSW)
Entity type:Individual
Prefix:MRS
First Name:MARSHA
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CAC-1, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3840 FAIRVIEW ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48214-1608
Mailing Address - Country:US
Mailing Address - Phone:313-331-8890
Mailing Address - Fax:
Practice Address - Street 1:3840 FAIRVIEW ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-1608
Practice Address - Country:US
Practice Address - Phone:313-331-8890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1-03962101YA0400X
MI68010789701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3022440Medicaid
MI1063545556OtherGENESIS HOUSE III