Basic Information
| Provider Information | |||||||||
| NPI: | 1316062052 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | INNISS-JOHNSON | ||||||||
| FirstName: | JOY | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LPC, CRC, CAAC, CCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4646 JOHN R. ROAD | ||||||||
| Address2: | JOHNSON D. DINGELL VA MEDICAL CENTER - MENTAL HEALTH | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482012410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3135761000 | ||||||||
| FaxNumber: | 3135761074 | ||||||||
| Practice Location | |||||||||
| Address1: | 4646 JOHN R. ROAD | ||||||||
| Address2: | JOHN D. DINGELL VA MEDICAL CENTER - MENTAL HEALTH | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482012410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3135761000 | ||||||||
| FaxNumber: | 3135761074 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2007 | ||||||||
| LastUpdateDate: | 12/23/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 6401007295 | MI | Y | Behavioral Health & Social Service Providers | Counselor |
ID Information
| ID | Type | State | Issuer | Description | 1366491136 | 01 | MI | MENTAL HEALTH | OTHER | 1366491136 | 01 | MI | JOHN D. DINGELL VA MEDICAL CENTER | OTHER |