Healthcare Provider Details

I. General information

NPI: 1164601597
Provider Name (Legal Business Name): ALFRENETT JOHNSON-ORR SOCIAL WORKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2007
Last Update Date: 11/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 ELMS COURT CIR
JACKSON MS
39204-4332
US

IV. Provider business mailing address

370 ELMS COURT CIR
JACKSON MS
39204-4332
US

V. Phone/Fax

Practice location:
  • Phone: 601-371-0115
  • Fax:
Mailing address:
  • Phone: 601-371-0115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberC2882
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC2882
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberC2882
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: