Provider Demographics
NPI:1992972046
Name:JOHNSON, SUZANNE (LMSW)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41800 HAYES RD STE 206
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1876
Mailing Address - Country:US
Mailing Address - Phone:586-799-2399
Mailing Address - Fax:586-649-2137
Practice Address - Street 1:41800 HAYES RD
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-1876
Practice Address - Country:US
Practice Address - Phone:586-799-2399
Practice Address - Fax:586-649-2137
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010328741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI750910402OtherBLUE CROSS