Individual
AMANDA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1059 EASTVIEW ST, JACKSON, MS 39203-3119
(601) 672-4090
Mailing address
1059 EASTVIEW ST, JACKSON, MS 39203-3119
(601) 672-4090
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
M7862
MS
Other
Enumeration date
04/04/2014
Last updated
04/04/2014
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