Healthcare Provider Details

I. General information

NPI: 1376355511
Provider Name (Legal Business Name): MARGARET REGENIA JOHNSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2025
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 HAMPTON HILLS CT
CANTON MS
39046-4417
US

IV. Provider business mailing address

102 HAMPTON HILLS CT
CANTON MS
39046-4417
US

V. Phone/Fax

Practice location:
  • Phone: 601-906-4280
  • Fax:
Mailing address:
  • Phone: 601-906-4280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM8483
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: