Individual
RAPHAEL DAVID JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, LLC
Contact information
Practice address
6070 NEWPORT RD, PORTAGE, MI 49002-9234
(269) 409-3000
Mailing address
6070 NEWPORT RD, PORTAGE, MI 49002-9234
(269) 409-3000
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
6451024063
MI
Other
Enumeration date
11/29/2024
Last updated
11/29/2024
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