Individual
MR. SAMUEL CASEY JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
805 S PEARL ST, IUKA, MS 38852-1824
(662) 660-4243
Mailing address
805 S PEARL ST, IUKA, MS 38852-1824
(662) 660-4243
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C10465
MS
Other
Enumeration date
01/31/2023
Last updated
01/31/2023
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