Basic Information
Provider Information
NPI: 1003142829
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SUNJKIC JOHNSON
FirstName: MARIJA
MiddleName:  
NamePrefix: MRS.
NameSuffix:  
Credential: MA, LPC, NCC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: SUNJKIC
OtherFirstName: MARIJA
OtherMiddleName:  
OtherNamePrefix: MS.
OtherNameSuffix:  
OtherCredential: MA, LPC, NCC
OtherLastNameType: 1
Mailing Information
Address1: PO BOX 679
Address2:  
City: SAINT JOSEPH
State: MI
PostalCode: 490850679
CountryCode: US
TelephoneNumber: 2699852000
FaxNumber: 2699852002
Practice Location
Address1: 903 MAIN ST
Address2:  
City: SAINT JOSEPH
State: MI
PostalCode: 490851426
CountryCode: US
TelephoneNumber: 2699852000
FaxNumber: 2699852002
Other Information
ProviderEnumerationDate: 10/29/2009
LastUpdateDate: 04/19/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP2500X6401011543MIY Behavioral Health & Social Service ProvidersCounselorProfessional
103TC1900X6401011543MIN Behavioral Health & Social Service ProvidersPsychologistCounseling

No ID Information.


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