Individual
LATOYA CORDRELLIA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
1500 E WOODROW WILSON DR, JACKSON, MS 39217-0001
(601) 940-8861
Mailing address
1500 E WOODROW WILSON DR, JACKSON, MS 39217-0001
(601) 940-8861
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
M6485
MS
1041C0700X
Clinical Social Worker
Primary
C6485
MS
Other
Enumeration date
09/28/2006
Last updated
06/16/2014
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