Individual
DR. THERESIA JOHNSON-RATLIFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.C.S.W.
Contact information
Practice address
251 ROSE ST, JACKSON, MS 39203-2560
(601) 988-5112
Mailing address
251 ROSE ST, JACKSON, MS 39203-2560
(601) 988-5112
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C0559
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09924236
—
MS
Enumeration date
09/14/2010
Last updated
09/14/2010
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