Organization
BLUE WATER SERENITY COUNSELING PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALEXIS JOHNSON LMSW,CADC (OWNER AND SOLE PROPRIETOR)
(810) 824-4865
Entity
Organization
Contact information
Practice address
5429 SHOREWOOD DR, FORT GRATIOT, MI 48059-3138
(810) 357-1725
(810) 824-4865
Mailing address
5429 SHOREWOOD DR, FORT GRATIOT, MI 48059-3138
(810) 357-1725
(810) 824-4865
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1609118637
NATIONAL PROVIDER IDENTIFICATION
MI
Enumeration date
11/19/2014
Last updated
12/08/2014
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