Healthcare Provider Details

I. General information

NPI: 1902611965
Provider Name (Legal Business Name): KIARA WILLIAMS JOHNSON DPC, LPC, NCC, NCSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2025
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4780 I 55 N STE 116
JACKSON MS
39211-6067
US

IV. Provider business mailing address

4780 I 55 N STE 116
JACKSON MS
39211-6067
US

V. Phone/Fax

Practice location:
  • Phone: 662-214-5554
  • Fax:
Mailing address:
  • Phone: 662-214-5554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3217
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number312666
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3217
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: