Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
N | 101YP2500X | Professional Counselor | 6401015058 | MI |
N | 101YS0200X | School Counselor | SC0000000889916 | MI |
NPI | 1215277231 |
---|---|
Provider Name | Mrs. Amber C Johnson |
First Address | Bay City, MI 48708-8407 |
Second Address | Bay City, MI 48708-7248 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2013 |
Last Update Date | 19/02/2017 |