Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 6401011543 | MI |
N | 103TC1900X | Counseling Psychologist | 6401011543 | MI |
NPI | 1003142829 |
---|---|
Provider Name | Mrs. Marija Sunjkic Johnson |
First Address | Saint Joseph, MI 49085-0679 |
Second Address | Saint Joseph, MI 49085-1426 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2009 |
Last Update Date | 19/04/2012 |