Individual
ANDRE L JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
18646 OXNARD ST, TARZANA, CA 91356-1411
(818) 654-3908
Mailing address
1121 E MCNICHOLS RD, DETROIT, MI 48203-2857
(313) 212-2998
(313) 365-3154
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
6301018288
MI
103TC0700X
Clinical Psychologist
6301018288
MI
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
09/02/2021
Last updated
07/18/2022
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