Individual
MR. TOMMIE EARL JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LLMSW
Contact information
Practice address
3584 FAIRLANES AVE SW STE 2, GRANDVILLE, MI 49418-1583
(616) 222-5300
(616) 531-0447
Mailing address
3584 FAIRLANES AVE SW STE 2, GRANDVILLE, MI 49418-1583
(616) 222-5300
Taxonomy
Speciality
Code
Description
License number
State
103TM1800X
Intellectual & Developmental Disabilities Psychologist
—
—
405300000X
Prevention Professional
Primary
680115877
MI
Other
Enumeration date
03/03/2021
Last updated
03/03/2021
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