Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | 6401015857 | MI |
NPI | 1003263229 |
---|---|
Provider Name | Lyndi Johnston |
First Address | Detroit, MI 48202-2412 |
Second Address | Detroit, MI 48202-2412 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2016 |
Last Update Date | 05/05/2021 |