| Doctor Name: | MR. THOMAS EDGAR JOHNSON |
| NPI Number: | 1639436173 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LMSW |
| License Number: | 6801011164 |
| Business Practice Address: | 19366 Allen Rd Ste C Brownstown Twp, MI - 481836810 |
| Business Phone Number: | 7344790949 |
| Business Fax Number: | 7344791637 |
| Mailing Address: | 9351 Willow Rd, WILLIS |
| State: | MI |
| Postal Code: | 481919725 |
| Phone Number: | 7344616447 |
| Fax Number: | |
| NPI Enumeration Date: | 04/23/2012 |
| NPI Last Update Date: | 04/23/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 6801011164 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |