Healthcare Provider Details

I. General information

NPI: 1467997296
Provider Name (Legal Business Name): JANICE MOORE HOPKINS JR. LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2017
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E NORTHSIDE DR STE C
CLINTON MS
39056-3663
US

IV. Provider business mailing address

801 E NORTHSIDE DR STE C
CLINTON MS
39056-3663
US

V. Phone/Fax

Practice location:
  • Phone: 601-259-6125
  • Fax:
Mailing address:
  • Phone: 601-259-6125
  • Fax: 601-473-2258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2129
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: