1316062052 NPI number — MRS. JOY ELIZABETH INNISS-JOHNSON LPC, CRC, CAAC, CCS

Table of content: MRS. JOY ELIZABETH INNISS-JOHNSON LPC, CRC, CAAC, CCS (NPI 1316062052)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316062052 NPI number — MRS. JOY ELIZABETH INNISS-JOHNSON LPC, CRC, CAAC, CCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
INNISS-JOHNSON
Provider First Name:
JOY
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC, CRC, CAAC, CCS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316062052
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4646 JOHN R. ROAD
Provider Second Line Business Mailing Address:
JOHNSON D. DINGELL VA MEDICAL CENTER - MENTAL HEALTH
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48201-2410
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-576-1000
Provider Business Mailing Address Fax Number:
313-576-1074

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4646 JOHN R. ROAD
Provider Second Line Business Practice Location Address:
JOHN D. DINGELL VA MEDICAL CENTER - MENTAL HEALTH
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48201-2410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-576-1000
Provider Business Practice Location Address Fax Number:
313-576-1074
Provider Enumeration Date:
03/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  6401007295 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1366491136 . This is a "MENTAL HEALTH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1366491136 . This is a "JOHN D. DINGELL VA MEDICAL CENTER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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