Individual
KIRA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1703 ST CHARLES ST, JACKSON, MS 39209-5406
(601) 353-2638
Mailing address
1703 ST CHARLES ST, JACKSON, MS 39209-5406
(601) 353-2638
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C6696
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06202806
—
MS
Enumeration date
08/22/2007
Last updated
08/22/2007
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