Individual
STEPHEN J JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
248 E CAPITOL ST, 840 TRUST MARK BLDG, JACKSON, MS 39201-2503
(800) 632-6074
Mailing address
1221 64TH CT, MERIDIAN, MS 39305-1124
(601) 693-5633
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
C0690
MS
1041C0700X
Clinical Social Worker
Primary
C0690
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00364895
RR MCARE W PARADIGM
MS
Enumeration date
08/01/2006
Last updated
08/14/2007
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