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Organization

WEDGWOOD CHRISTAIN SERVICES

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. ROBERT GERARD JOHNSON SR. LPC (THERAPIST)
(616) 559-5835
Entity
Organization

Contact information

Practice address
3300 36TH ST SE, GRAND RAPIDS, MI 49512-2810
(616) 559-5835
(616) 281-6448
Mailing address
8117 CRESTVIEW AVE, JENISON, MI 49428-9124
(616) 706-0204

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
100594
ADDICTION COUNSELOR
MI
01
6401008579
PROFESSIONAL COUNSELOR
MI
Enumeration date
03/14/2007
Last updated
08/22/2020
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