Organization
MELITA TRAVIS JOHNSON, LMSW, CCDP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MELITA TRAVIS JOHNSON LMSW, CCDP (THERAPIST CONSULTANT)
(616) 481-9337
Entity
Organization
Contact information
Practice address
770 KENMOOR AVE SE STE 103, GRAND RAPIDS, MI 49546-8602
(616) 481-9337
(616) 719-3119
Mailing address
1130 ELMDALE AVE NE, GRAND RAPIDS, MI 49525-2632
(616) 481-9337
(616) 719-3119
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
6801063274
MI
Other
Enumeration date
12/09/2014
Last updated
12/09/2014
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