Basic Information
| Provider Information | |||||||||
| NPI: | 1003409822 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | RACHEL | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2389 GOLFVIEW CIR | ||||||||
| Address2: | |||||||||
| City: | FENTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484309629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8108778222 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8240 EMBURY RD | ||||||||
| Address2: | |||||||||
| City: | GRAND BLANC | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484397113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8107772000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2021 | ||||||||
| LastUpdateDate: | 12/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801113715 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.