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General NPI Number Information
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NPI Number | 1851700249
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Entity Type | Organization
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Legal Business Name | JOURNEY COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 08/11/2014
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Last Update Date | 05/01/2015
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Provider Practice Location Address
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Address Line | 2080 DUNBARTON DR SUITE 1
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City | JACKSON
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State | MS
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Zip | 39216-5016
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Country | US
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Telephone | 601-982-0948
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Fax | 877-907-6577
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Provider Business Mailing Address
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Address Line | PO BOX 59397
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City | JACKSON
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State | MS
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Zip | 39284-9397
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Country | US
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Telephone | 601-982-0948
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Fax | 877-907-6577
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MRS. KIRA JOHNSON
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Credential | LCSW
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Telephone | 601-982-0948
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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 | C6696
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License Number State | MS
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