Healthcare Provider Details

I. General information

NPI: 1063888402
Provider Name (Legal Business Name): JOYCE M HEWITT DSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2015
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1585 3RD ST
FORT JOHNSON LA
71459-5102
US

IV. Provider business mailing address

1585 3RD ST
FORT JOHNSON LA
71459-5102
US

V. Phone/Fax

Practice location:
  • Phone: 252-538-6124
  • Fax:
Mailing address:
  • Phone: 253-861-2423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCSW03383
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberCSW03383
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberM8682
License Number StateMS
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW03383
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: