Individual
AMANDA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PCMHT
Contact information
Practice address
1501 LACKEY ST, LEAKESVILLE, MS 39451-3108
(601) 394-5047
(601) 394-6542
Mailing address
PO BOX 18679, HATTIESBURG, MS 39404-8679
(601) 705-1901
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
5930
MS
Other
Enumeration date
06/16/2023
Last updated
06/16/2023
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