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Individual

JENNIE-MARIE GWEN JOHNSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MA, LLP, CAADC, CTS

Contact information

Practice address
79 W ALEXANDRINE ST, DETROIT, MI 48201-2015
(313) 831-5535
Mailing address
79 W ALEXANDRINE ST, DETROIT, MI 48201-2015
(313) 831-5535

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
C-01244
MI
103TC0700X
Clinical Psychologist
Primary
6301012115
MI

Other

Enumeration date
10/31/2012
Last updated
10/31/2012
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