Individual
DERRECK JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LLPC, DP-C
Contact information
Practice address
1555 INDUSTRIAL DR, OWOSSO, MI 48867-9775
(989) 723-6791
(989) 725-5061
Mailing address
1321 S FAYETTE ST, SAGINAW, MI 48602-1447
(989) 792-8000
(989) 792-8445
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YP2500X
Professional Counselor
Primary
6401015200
MI
Other
Enumeration date
08/04/2015
Last updated
10/12/2017
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