Provider Demographics
NPI:1447642566
Name:JOHNSON, BRIDIE MAE (LCSW, LMSW, CCS, LAC)
Entity type:Individual
Prefix:MS
First Name:BRIDIE
Middle Name:MAE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW, LMSW, CCS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18701 STEEL ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-1328
Mailing Address - Country:US
Mailing Address - Phone:404-983-6385
Mailing Address - Fax:720-571-1261
Practice Address - Street 1:1563 MISSION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2543
Practice Address - Country:US
Practice Address - Phone:404-983-6385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-26
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIC-03921101YA0400X
MIS-03921101YA0400X
COCSW.099274831041C0700X
MI68010801441041C0700X
MIMI-02985374J00000X
CA1202291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No374J00000XNursing Service Related ProvidersDoula