Individual
DR. BENETRA MANGUM-JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD, LCSW
Contact information
Practice address
2500 N. STATE ST., DEPT. OF PSYCHIATRY AND HUMAN BEHAVIOR (H808), JACKSON, MS 39216
(601) 815-6337
Mailing address
2500 NORTH STATE STREET, CBO - SUITE 4200, JACKSON, MS 39216-4500
(601) 496-9794
(601) 815-0434
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C7180
MS
Other
Enumeration date
07/11/2019
Last updated
07/11/2019
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