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General NPI Number Information
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NPI Number | 1578876280
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Entity Type | Individual
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Provider Name | JOY A. WEIDEMANN LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/22/2010
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Last Update Date | 05/31/2018
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Provider Practice Location Address
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Address Line | 120 STREET A STE C
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City | PICAYUNE
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State | MS
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Zip | 39466
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Country | US
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Telephone | 601-215-6087
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Fax | 601-799-3536
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Provider Business Mailing Address
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Address Line | 120 STREET A STE C
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City | PICAYUNE
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State | MS
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Zip | 39466-5466
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Country | US
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Telephone | 601-215-6087
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Fax | 601-799-3536
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | M7533
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C7533
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License Number State | MS
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