Healthcare Provider Details

I. General information

NPI: 1427441005
Provider Name (Legal Business Name): JOSEPHINE MIXSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOSEPHINE JENKINS

II. Dates (important events)

Enumeration Date: 03/06/2015
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 E PRICE ST
PHILADELPHIA PA
19144-2147
US

IV. Provider business mailing address

229 E PRICE ST
PHILADELPHIA PA
19144-2147
US

V. Phone/Fax

Practice location:
  • Phone: 609-617-6163
  • Fax:
Mailing address:
  • Phone: 609-617-6163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00484400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: